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A SOBERING STORY: Don't put off conversation with addict, specialists say

by on May 04, 2014 2:00 AM

Talking to a loved one about his or her addiction is difficult. It requires some compassion when anger may be all that’s left, persistence when failure is all there is to show for it, and tough love when instincts say that it’s wrong to be so harsh.

And to make it all the more stressful, there is no one precise thing to say that will persuade an addict to enter treatment.

Still, it’s a conversation that must be had, regardless of whether that conversation comes as a quick and informal aside or as a lengthy and formal intervention. And the sooner it happens, the better, according to addiction specialists.

“As soon as you see a difference in a person’s behavior, I think that’s the time to pull them aside and say, ‘What’s going on?’” said Laurie Roehrich, an Indiana University of Pennsylvania professor and clinical psychologist who specializes in addictive behavior.

Roehrich said addiction mythology holds that an addict must hit rock bottom before they’ll accept they have a problem and that those around them are powerless to do anything about it in the meantime.

“I would caution people that that’s not really true,” Roehrich said. “We don’t have to wait for that to happen. It’s OK to say something early. The earlier we can intervene, the more likely it is the person can begin to notice their own behavior.”

Roehrich said those sorts of discussions don’t have to occur in the context of a formal intervention.

“It can be as simple as pulling the addict aside and saying, ‘I’m worried about you,’” she said.

“Those kinds of talks can be consciousness-raising for the person. They can be motivational. They can be giving them some accurate feedback about how other people perceive their behavior,” she said.

She also said those close to an addict should not put off such discussions on fears that it will evoke an angry response. Although the addict may very well become angry, friends and family should not automatically assume that will be the case, she said.

Moreover, putting off the conversation only allows the problem to become worse.

“We tell ourselves all kinds of things, and it prevents us from saying anything until things really are out of control,” Roehrich said. “The reality is … some folks really are willing to hear (your concerns).”

And they likely will be more inclined to hear your concerns when they’re sober, or, at least, more sober than inebriated. So, specialists say, it’s important to put off such conversations for a time when the addict is of clearer mind.

“You want to wait until they’re not using. That’s easier said than done if they’re using all the time, but in general you want to wait until they are coming down,” said Vince Mercuri, executive director of The Open Door Alcohol and Other Drug Treatment Center.

Otherwise, he said, you wind up speaking to the drug — “You’re not talking to the person.”

When the opportune time to say something presents itself, you’ll want to choose your thoughts carefully and check the negative emotions, Mercuri and others said. Therefore, blame, shame, insinuations, yelling and preaching should be avoided.

“This is not supposed to degenerate into a guilt infliction,” said Ralph May, chief clinical officer at the Community Guidance Center in White Township.

“Inflicting guilt on somebody is ineffective. These people feel guilty enough already, even though they may not show it,” he said.

May said the talk should be firm, but loving and supportive. And it should include some path forward.

“It can’t be simply calling the person out,” he said.

Mercuri said these conversations are never comfortable ones to have — they are in essence a confrontation. So, he said, he tries to approach them as “care-frontations,” conversations in which friends and relatives state their concerns and suggest treatment in a loving, dignified and supportive way.

“I watch my voice tone. I don’t blame. I don’t point. I don’t call you a liar. I don’t back you into a corner,” Mercuri said.

To help remove the emotion from what already is an emotionally charged discussion, he said the talk should be nonjudgmental and limited to what is factual.

So observations such as “Your grades are dropping” or “You threw up in a laundry basket last night” are OK. Statements such as “I can’t stand your behavior” or “You make me so mad” would not be, he said.

He also said that the discussion may include talk of boundaries and limits, lines that you as the person close to an addict are not willing to cross. Mercuri said setting those boundaries really aren’t for the benefit of the addict and his or her recovery; they’re for you.

“If I set a boundary with you, it’s because I’ve made a decision that your behavior is not acceptable nor appropriate.”

The boundaries should be clear, concrete and consistent, and should carry consequences if they are crossed, he said.

One of those consequences may be telling a family member to leave the home if they refuse treatment. But he said that’s something that should be thought through thoroughly. And, he said, it’s not always a necessary step.

“I’ve never told a family member you need to throw your loved one out,” Mercuri said. “I don’t know that I could do that. But I have said to them, ‘One of your options is you can throw them out.’”

Setting boundaries isn’t about bullying a person into recovery; it’s a way to create leverage and motivate the addict to enter recovery, said Carol Lawyer, a West Chester-based interventionist and family therapist.

“It’s about helping them to make a good choice,” said Lawyer, who also serves as a director for the nonprofit Pennsylvania Certification Board, an organization that issues credentials to behavioral health professionals.

Setting boundaries also is important for the health of those around the addict.

“You’re setting that boundary for you,” Mercuri said. “You’re walking around on eggshells because of this person’s addiction. At some point, you need to take care of yourself, and part of taking care of yourself may be ridding yourself of the reality of that addiction.”

Whatever limits you do establish, you should be prepared to stick to them, Mercuri said.

“Don’t say it unless you mean it because they are going to test you. Whatever limits and boundaries you’re setting, be prepared to enforce it. If you don’t, they’re going to view that as they got one over on you,” Mercuri said.

But Roehrich said threats and punitive actions should be weighed carefully — the end result could be that you sever communication with the person who is addicted. That, she said, obviously is opposite of the desired outcome, which is for the addict to get help.

She said research shows that people tend do better in treatment if they feel as if the choice to enter treatment was theirs to begin with. By the same token, she said, the data shows that people who are forced into treatment by their families don’t do quite as well.

However, that’s not to say that prodding someone into treatment never works, Roehrich said. Because sometimes it does. As an example, look at people who are remanded into treatment through drug courts, special judicial programs that try to steer defendants in criminal cases into recovery in lieu of incarceration.

“Most people who end up in drug court didn’t necessarily want to be in treatment, but some of them do very well,” she said. “Being remanded into treatment sometimes does work.”

But then sometimes it doesn’t.

Sometimes addicts aren’t ready for treatment. Or to admit they even have a problem. So there’s a good chance that the first go-around will end unsuccessfully.

Therefore, May said, loved ones should approach discussions about treatment as the first step in a long process, not as the beginning of a soon-approaching end.

“Ultimately your hope is the individual who is struggling with the addiction begins to recognize, on some level, that this can’t go on, that this has to stop. People often reach that recognition multiple times before they are able to embrace their full recovery,” he said.

Mercuri, too, said it’s a process, especially as those suffering from addiction tend blame everybody but themselves for their problems.

“You don’t break through denial. You chip away it and soften it,” he said.

So, specialists said, if the addicted person continues to deny that he or she has a problem or refuses to seek help, the next step is to get help for yourself.

And that, they said, includes educating yourself about addiction, seeking personal counseling and reconnecting with other family and friends.

“Once you’ve expressed your concern to your family member, then it’s about taking care of yourself and getting the care you need,” said Anna Shuster, clinical director of ARC Manor in Kittanning.



Sam Kusic is a staff writer for The Indiana Gazette.
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