The headlights of the SUV swept  across the face of the gray contemporary home just before dawn. Ever so quietly, the doors of the SUV opened as two beefy men emerged and glided like practiced dancers across the walkway to the back of the house where Diane was waiting.  Heart pounding, Diane* slid the doors open, greeted them with a curt nod, and escorted them down the dark hallway to Jake’s room.

Vaguely sensing someone’s presence, Jake awoke shielding his eyes from the harsh overhead light his mother had just switched on.  As his eyes focused, he took in the sight of the men standing behind Diane, and knew in an instant that they were here for him.  Although unsure of whether the nightmare of his drug life was over or just beginning, Jake knew with certainty that there was no escaping these men, handcuffs and leash in hand.   Ready or not, the escorts would ensure his safe, if not reticent, delivery to a treatment program in Utah.

While this probably sounds like a scene from a made-for-TV melodrama, it actually played out at our neighbor’s house several years ago as they desperately struggled to get their son, Jake, into treatment.  He had adamantly refused

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The word recovery – synonymous with mending, healing and improvement – is not only a possibility for all of us, but a reality.  Recovery for my stepdaughter Katherine will always be a work in progress, ever changing and full of possibilities.  Our family works everyday to continue the healing and mending process.  Letting go and allowing your loved one to take responsibility for themselves and to move onward with a sense of self-worth is one of the greatest gifts you can give or receive.

We now, with some trepidation, try not to watch Katherine too closely, overreact or analyze her every move.  We are constantly aware of how easy it is to fall back into our old habits of trying to be the “fixers” when it’s Katherine who should be held accountable.  Now, we work on letting her take control of her own life and

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When my daughter was spinning out of control from her addiction, there were difficult decisions to be made. One of the most frustrating things was seeking treatment options for her. I spent a lot of time, effort, and money on programs that did not work — before finding a successful solution.

Failed attempt number one began when I called the number on the back of my insurance card and followed the recommendation to admit Lauren into an adolescent psychiatric hospital. Most of their patients were there for severe mental and emotional problems that required medication. They were not prepared to take on a case like Lauren and made many suggestions that were actually detrimental, like suggesting I send her away to spend time with relatives after her release. Even with ongoing counseling, once she returned home, she was back to business as usual.

The second attempt was a local hospital offering an outpatient substance abuse program. This was equally dismal since their primary strategy for helping her was telling her she needed to change her ways.  When the head counselor informed me they were kicking her out of the program because she was still using drugs and supplying them to other patients, I fought back.  Why did they think I had her there in the first place?  Weren’t they supposed to be the experts?

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I was 17 years old when I walked in on my own drug intervention.  It couldn’t have come soon enough, but I realize today that it almost came too late!  My time was running out and it was exactly what I needed to help me make the decision to enter a treatment facility that specialized in teen substance abuse and addiction. 

As a teen addict, I justified my behavior because I didn’t suffer the same ramifications that most adults in my situation would (loss of home, family, marriage, job or health). I thought I was invincible and that once things got “really” bad, I could stop on my own.  In reality, I did lose a lot due to my drug and alcohol addiction.  Though I did not have some of the more severe consequences of an adult in my situation,  I certainly experienced consequences. Here’s a list of some of them: 

* I threw away friendships and had friends walk away from me, leaving feelings of loneliness.
* I lost my parents’ trust so that even when I was being honest with them they still couldn’t trust me.
* I lost all motivation to go after my goals and dreams since my ultimate motivation was to get high.
* I lost my desire to help my mom around the house.
* I lost my desire to be a good example for my younger brother.
* I lost motivation to study and stay in school, since that ultimately it got in the way of my using.
* I lost motivation for any extracurricular activities.

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Despite the fact that my son Alex was cutting his sophomore classes and ignoring mounting piles of homework assignments, he readily morphed into a Constitutional scholar right before my very eyes whenever it came to the subject of privacy.  He had no aspirations to be a lawyer, but argued like one, vehemently stating that privacy was a basic human right, protected under the auspices of the 9th Amendment.  In his pursuit of life, liberty and unfettered drug use, he felt that his room, belongings, computer, and cell phone were off limits to parental scrutiny. 

As he was growing up I gave him what I thought was age-appropriate privacy, but once Alex broke the rules of our home by using substances, all bets were off.  I was waging an all out war against substance use and I needed as much information about my enemy (drugs) as possible.  Not only did it give me a handle on what was going on, but it allowed me to share information with his therapist so that we could determine the appropriate level of intervention – more therapy, an outpatient or inpatient program.

While he was actively using, I found drugs and drug paraphernalia in the most creative places – inside an electric pencil sharpener, under the rug in a corner of the closet, and inside books where pages had been cut out, not to mention clothing pockets and his backpack.  Checking Facebook and text messages on his cell phone also proved to be enlightening with messages like “R U puffin 2nite?”  Although I did not use computer-monitoring software like eBlaster to track instant messages and email, some parents do this as well.  

When I found my postal scales in his room, I immediately suspected that in addition to using, Alex was most likely dealing, a realization that terrified me on so many levels – his escalating drug use, the danger of dealing with drug dealers and the legal implications, to name a few. 

I carted everything I had found with us to Alex’s next therapy appointment, placed it on his therapist’s table with a dramatic flourish and said, “What do we do about this?”  As recognition flitted across Alex’s face, he blanched while the therapist commented that it didn’t “look good” and he would talk to Alex in more detail while I cooled my heels in the waiting room.

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Alcohol and drug abuse was an issue we never talked about in my family.  My father was an alcoholic himself, fighting his own demons with addiction. No one talked to me about all the insanity that had gone down in my family, which included the fact that both of my parents, and some of my grandparents, suffered from addictions of their own. Everyone just wanted to sweep everything under the rug and put on a happy face. 

The problem was that my insides did not match up with the image I was expected to portray. I was left to figure it out on my own.  As a teenager, I vowed to never drink the way my dad did.   Little did I know that I had a genetic predisposition to become an alcoholic and an addict just like he was — and it wasn’t too long before I found myself fighting my own battle with addiction.

With little parental guidance, I found myself easily influenced by my peers.  They were the ones I turned to for the guidance I was lacking at home.  I had low self-esteem and hadn’t been taught positive decision-making skills.  My decision to try drugs for the first time was voluntary. I did it to fit in.  Maybe it would have helped if I’d heard my parents’ voice in the back of my mind telling me that I was making a bad choice, but those voices just weren’t there. Instead that first high gave me was a sense of wholeness and confidence that I had never felt before. 

I felt like I had finally found the thing that was going to fix me. My low self-esteem seemed to disappear when I was high, and the feelings of emptiness were temporarily gone. But after a while of numbing myself, no amount of drugs or alcohol could take away the emotional pain and insecurities I felt inside. Getting high just gave me artificial confidence and when it wore off I felt an overwhelming sense of loneliness and fear of not knowing how to stop abusing drugs and alcohol, or who I could trust or turn to for help.  What at first seemed like a way to have fun and fit in soon turned on me and started to feel like riding in a car without any breaks. I didn’t know how to stop my addiction.

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With our emotional wound still open, our entire family, including my stepdaughter Katherine, began the process of building back the trust we once shared.  This would prove to be rewarding as well as exceptionally painful. 

Sitting, circular fashion in a room with at least 10 other families we openly disclosed our feelings of anger, fear, loneliness, distrust as well as resentment.  “Family Week” had begun and there would be no holding back as we were guided through various discussions with our loved ones.  The building blocks to fostering a new cohesive, trusting and loving family were being tossed around the room while we slowly, and painstakingly, examined the cracks that were created, their affects and how to seal them and move on.

The dynamics within the family are key to opening the doors to change.  When an addiction is present the need it is vital to focus on new ways of coping and “non-enabling” behaviors.  Both patients and family members often rationalize behaviors which creates an environment that hangs around like a thick fog — perpetuating feelings of inadequacies and creating the dysfunctional cycle that is extremely hard to break.

There were at least four general areas of focus that our family concentrated on, which I elaborate on below.  Keep in mind, that although I went through the recovery process with my stepdaughter, I am not a certified authority; I was just a family member trying to recapture and rebuild what was lost.  Every family’s issues will be different, yet similar in many ways.  Issues will surface and may compound as you work on restructuring your family -– it’s not easy.  But having experts, who allowed us to express our emotions and feelings in a controlled, safe and healthy environment, was incredibly instrumental.

1. BLAMING:  DO WE BLAME OURSELVES OR OUR CHILD?

It almost goes without saying that when an addiction is present, family members will find the blame game is alive and well.  We had elements of blaming ourselves as parents and role models, believing that the reason Katherine defied everything we believed in was an attempt to “get back” at us for our wrongdoings. 

At Family Week we opened up the floodgates, allowing ourselves to examine with minute detail (on both sides) where our thinking had been

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Today, I want to talk about what alcohol and drug addiction really is — a chronic medical disease of the brain. I believe if we treat the disease as such, long term success rates will greatly improve, in most cases.

One of the positive trends that is helping increase acceptance of a medical approach to alcohol and drug addiction is the growing awareness that substance dependence is not a moral failure, but rather a chronic medical disease with similarities to other chronic medical diseases such as diabetes, hypertension, and asthma. It was only within the last 20 years that researchers began to realize substance dependence is a brain disease – a medical condition with a neurobiological basis that causes lasting changes in the brain — changes that don’t go away, sometimes for months or years, even after recovering patients stop.  Alcohol and drug use can cause changes in the brain’s structure and functioning.  For example, the brain’s communication system is impacted by drug use, interfering with the way nerve cells send, receive, and process information. Other areas in the brain impacted by drug use include:

• Cortex — the outer area of the brain, which contains the most highly evolved cells, where abstract thinking and higher cognitive processes occur, allowing us to think, learn, and understand.
• Limbic Region — the brain’s reward circuit that links together different brain structures that control and regulate our ability to feel pleasure. The limbic system is activated when we perform activities that help us feel pleasure — and also by drugs of abuse. The limbic system is also responsible for other emotions which explains the mood-altering properties of many drugs.
• Hippocampus — an area adjacent to the limbic region where many long-term memory cells reside, all of which are “plugged in” to the limbic region’s emotional circuits. 

The result is an altered brain that’s learned to do the wrong thing, over and over again.* Unfortunately, brain changes related to drug use and addiction are not a “quick come, quick go” (an acute disease).  Like diabetes, asthma, and other chronic diseases, addiction is a chronic disease. Your diabetes is not cured simply because you’re taking your medicine and watching your diet; it may be managed, but it’s still present. It’s the same with the disease of addiction; it can be managed successfully but it is a chronic disease.

Because addiction is a chronic disease, relapse is not only possible, for the majority (40 to 60 percent) it is very likely to happen. This does not mean treatment has failed, it means, as with other chronic diseases, that treatment needs to be readjusted to understand the physiological and behavioral factors that contributed to the relapse. If we look at the relapse rates for other chronic disease such as diabetes (30 to 50 percent), asthma (50 to 70 percent), and hypertension (50 to 70 percent), we see similar rates of relapse. 

There are no quick fixes for any chronic illness including addiction, which is why patients deserve sympathy and support, even when they relapse. We don’t condemn a diabetic for having a sugary dessert or forgetting to take his or her medicine; we don’t revile the person with hypertension who gains weight instead of losing it. Instead, we sympathize with and try to understand what caused them to to slip up despite having a chronic illness and we encourage them to take their medicines regularly and stick to a health-enhancing eating and exercise plan. We understand, in spite of the health consequences, people with chronic diseases such as diabetes, asthma, and elevated blood pressure often do neglect to follow their doctors’ orders. Less than 50 percent of patients with these diseases take their medicines as prescribed, and less than 30 percent comply with lifestyle changes recommended by their doctors, according to the Institute of Medicine Study of Chronic Diseases.  Why should we treat those with substance abuse addictions differently?

The good news about all of this is that once we understand this extremely important information and treat alcohol or drug addiction like a chronic disease, then patients can start to have long term, successful recovery.

Another key component to addiction treatment is the anti-addiction medications designed to rebalance the brain’s biochemistry.  I will be talking more about these anti-addiction medications in future posts on this blog. These medications help correct imbalances in dopamine and other essential neurotransmitters and accelerate healing of the physical damage in both the limbic region and the cortex. Once this damage has been repaired, a person with addictions will find it much easier to learn, remember, and focus on the cognitive and behavioral changes used in talking therapy and achieve longer-lasting sobriety.

But let me be perfectly clear about one thing: I’m not saying that the new medicines are a magical cure or that we can forget the other treatments. Talking therapies (including the 12-step programs) are still essential to the recovery process, as are mastering new coping skills and making permanent lifestyle modifications. Insulin alone isn’t the solution for a diabetic, who must also learn how to eat a healthful diet, exercise regularly, remain slim, check his feet for cuts and sores that may become infected, and otherwise adhere to a good-health program. Neither are the new medications a simple solution to addiction. Successful addiction treatment requires a comprehensive approach, just like any other chronic medical disease. I will discuss more of this comprehensive approach in my next post. Thanks for reading.

*Some material from this post is excerpted from my book Healing the Addicted Brain.

“I found Lisa* sitting on the couch, asleep I guess or maybe passed out, with a half-eaten apple in her hand.  She looked awful.  I saw her purse on the floor and rummaged through it to see if I could figure out what she was using.  That’s when I found these little baggies labeled ‘Friends of the Night.’  I woke Lisa up and asked her what they were.  She told me they were vitamins and I sort of believed her, but I flushed them down the toilet anyway,” Marcie* explained, her voice marked with raw pain as she concluded her long and tortured story about her daughter Lisa’s drug-related adventures. 

Marcie had called me at the direction of our pastor who was familiar with our own journey in through this nightmare.

“Do you think she’s an addict?” Marcie asked me anxiously.  I knew this question so well as it was one that I wrestled with as we began to peel back the layers of our son’s drug use.  Is it really possible that the child you raised with so much love and self-sacrifice could actually be an addict?

Personally I dislike the term “addict” — for me it conjures up the picture of an anorexic-like figure slumped in a garbage-strewn gutter with a needle plunged into a vein, escaping into the euphoria of heroin.  That certainly was not the picture of our son, who, when using was occasionally glassy-eyed, but to the uninformed, was the picture of health. 

When used in conjunction with dessert or a sports team, the word addiction takes on more passionate overtones, as people gush about their chocolate cravings or the Yankees-Red Sox rivalry.  In contrast, addiction paired with substance abuse evokes so many negative images and emotions.  Although a convenient label, the term addict does not begin to describe the level of use, its impact on the user and his or her family, and underlying issues that may have contributed to the problem.  

Early in my son’s recovery I attended an AA meeting with him where one of the speakers joked, “I love to drink but every time I have a beer I have an allergic reaction – I break out in handcuffs.”  I think he was on to something – some can tolerate substance use (like the occasional glass of wine or a beer), while even the smallest amounts can be toxic for others, as with any other kind of allergy.

I told Marcie that I was not in a position to label her daughter— it was up to Lisa to make that determination.  Instead I asked her to focus on Lisa’s behaviors – the loss of interest in her favorite activities, failing her college classes, her erratic sleep patterns, the missing money and checks, her new friends, the many car accidents, unexplained absences from home, not wanting to be with family, etc.  All of Lisa’s behaviors added up to a level of substance use that required treatment.  Given what Marcie had disclosed, I suggested that she explore various levels of intervention with a professional substance abuse counselor or interventionist. Getting help was paramount – not the label.

*not her real name

When making a decision that dramatically impacts the life of a loved one, we sometimes act in a very irrational way.  In the beginning, I was jumping without a parachute, reacting on impulse and intuition.  We were frantic, looking for a quick fix, anything to get our daughter back.  In hindsight, while some of my decisions and gut reactions helped save my stepdaughter Katherine’s life, others could have been handled better. 

Now that I’ve gone through the process as a parent and have talked with so many people in recovery, I’d like to share some fundamental processes that may help those searching for the first time for a treatment center that works for them.
 
Below are my personal recommendations that may help you to navigate through the maze of in-patient treatment centers:

1. Because addiction is still somewhat considered an “unacceptable disease” we found it extremely hard to open up and reach out to friends, outside family or others for help and treatment center recommendations.  Due to my experiences and the experience of others, I am making great strides to raise awareness for the disease in hopes of ridding its stigma and making it a part of our nation’s dialogue.  But my mission starts with people like you.  I urge you to demand information from local health professionals, to share your experiences with others facing similar afflictions — in your local communities, schools, places of worship and on this blog.  Talk with community leaders and school counselors and discuss treatment centers in your area that have proven to be successful.  Then approach the ones that seem to fit your needs.

2. Do your own research online but be prepared to weed through an enormous amount of material – some informative, some self-promoting.  There is a wealth of information regarding various treatment modalities as well as questions for you to consider before picking up the phone to make the first call.
 
3. Once you have narrowed down your search, ask every conceivable question about the treatment center, questions such as:

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