Ask Jeff and Debra

Treatment Didn’t Work?

A question from one of our readers:

 

Dear Jeff and Debra,

 

My husband went to treatment, but he started drinking again after he got home. He was only there nine days, but it didn’t seem to help at all.  What can we do? I’m so frustrated!

 

 

 

Dear Frustrated,

 

We feel your pain. Families are always shocked when they learn how little time a person gets in a residential treatment program. After waging a long battle to get their loved one to accept help, they expect the person will be away and in treatment for at least a month. Unfortunately, that’s not the case.

 

What your husband received is more properly called detoxification and stabilization, rather than treatment. Once a person has been medically stabilized, has received basic education, and has received a continuing care plan, they are discharged. The next phase is typically an IOP (intensive outpatient program), meeting at 3 to 5 times per week for 6 weeks. Not many patients comply.

 

When resources allow it, we recommend 30 to 90 days of residential treatment. The “gold standard” used for airline pilots and physicians who need treatment is 90 days—and that’s just the start.

 

Your husband’s focus has to be on Twelve Step meetings and outpatient services. Right now, the goal should be to consult with his doctor, keep it simple, and start over. The old prescription of “90 meetings in 90 days” is a good place to begin. He’s had a bad fall, but it’s time to get up and try again. There are many recovering alcoholics in our community who’ll be happy to help him.

 

 

This post was also published in the Grosse Pointe News

Modeling Adulthood

Girl-Imitating-AdultKids notice everything. As they move into their teen years they notice more of everything and with a more discerning eye. They’re constantly adapting themselves to the world around them and evaluating the actions of others. Young people want to grow up fast, so they pay special attention to adults.

 

If kids see that adult gatherings always include alcohol, it sends a message that will be received loud and clear. The message is: if I’m an adult interacting with other adults in a social setting, I should be drinking. Children are the only ones who aren’t allowed to drink. If I’m going to be one of the grown-ups, I need to drink.

 

When extended family and friends come over for a holiday celebration, an adult birthday or a special occasion, is alcohol always part of the program? If so, the point about adulthood equaling alcohol is being reinforced.

 

How about sending a richer and more nuanced message. Yes, adults may drink alcohol, but alcohol isn’t a requirement for adults to get together. Take some time to plan adult family activities that don’t include alcohol, where everyone is having fun together without drinking. This possibly strange behavior will be noted and if alcohol normally plays a big role in your family, the message will be puzzled over by your kids. That’s a good thing.

 

Be sure your kids see the different ways you have to relax and take time for yourself. Work out, read a book, work on a project. You won’t have the luxury of isolation because you live in a house with kids, but you can demonstrate the various ways that adults relax, without using substances.

 

If a problem does arise with substance abuse in your household, get some help. When you think about it, it’s the only sensible thing to do. If you had transmission problems with your car, you wouldn’t attempt to become a transmission specialist overnight. Why would you? You’d get professional help with the problem.

 

The brain of a young female will continue to develop until the age of 21 to 23. For males, brain development continues until the age of 22 to 24. The regular use of alcohol, marijuana and other drugs can impact the developmental process in a negative way. It may not be realistic to expect that your children will abstain from all substances until they complete their developmental process, but they should be made aware of the dangers. It also gives a reasonable and scientific basis for firm boundaries and expectations in the household.

 

Your kids will be exposed to alcohol and other drugs early in their teen years, if not earlier. Make sure you learn how to communicate with them before someone else does. And as always, actions speak louder than words.

 

– Jeff Jay

 

 

Relapse Prevention

image by photostock

Dear Jeff and Debra,

 

My wife is just returning from a month of inpatient addiction treatment. She had a terrible problem with pain medication, which started of innocently enough when she had a skiing accident two years ago. After the problem spiraled out of control, we had a family intervention and got her into treatment. We were all relieved she accepted help, but now that she’s coming home, a whole new set of fears have taken hold. What can I do to help prevent a relapse?

 

A Concerned Husband

 

 

Dear Concerned,

 

As you know, treatment is a launching pad for recovery, not a cure for addiction. Treatment is vitally important, but it’s not a panacea. In treatment your wife learned how to work a program of recovery. You can’t work her recovery program for her any more than you could work an exercise program for her.

 

But that doesn’t mean that you don’t have an important role to play. First of all, you can scour the house to make sure there are no narcotic painkillers, muscle relaxants, tranquilizers or other suspicious prescriptions anywhere in the house. She doesn’t need to find some forgotten bottle oxycodone in the medicine cabinet.

 

Next, we would recommend that you remove all alcohol from the household. Although you have only reported your wife’s problem with prescription pain medication, the shortest road to relapse for her is probably through a social glass of wine. The phenomenon of cross-addiction is unappreciated and underestimated by most people, and it’s the cause of many preventable relapses.  She will have learned in treatment that she cannot safely drink alcohol from this point forward, and you can play a major role in making that fact easier to bear.

 

In social situations, join her in not drinking alcohol. It’s not such a big deal in our modern era, as many people decline alcohol for a variety of health and personal reasons. It’s easy enough to have a glass of juice or a soft drink at a party, and most people will never know or care. She’ll appreciate your solidarity with her and it will help quell her concerns about what other people might think. The fact is, when a person makes a fuss about another person not drinking, it says more about the drinker than the abstainer.

 

Third, you can begin working your own program of recovery, as a family member. We’ve written about Al-anon in this column many times, and there are also family programs specific to narcotics, though in our area we don’t find them to be as strong or well-developed (a pity really, as there is no shortage of prescription drug addicts —recovering and otherwise— in our community).

 

We hope that you attended the Family Program at the center where you wife was receiving treatment. The Family Program is your launching pad, and just like her treatment, it is only the beginning of the process. One of the best things you can do for your wife and yourself is to become very knowledgeable about the illness and about the recovery process, just as you would if she had contracted any other life-threatening chronic illness. Read all you can, attend open meetings of Alcoholics Anonymous in our community (there’s an eye opener!) and attend your own 12-Step meetings. This last point will serve two purposes: it will show camaraderie with your wife and it will give you greater insight into yourself. In particular, it will help you to see how you may have unwittingly enabled the problem to grow in the first place.

 

Finally, before your wife comes home from treatment, you should meet with her and her primary counselor to develop a Relapse Agreement. Its purpose is to spell out in black and white exactly what steps will be taken if there is a return to addictive behavior. Like the lines on a highway, a Relapse Agreement helps keep people on the road to recovery by making boundaries clear and consequences certain. It’s too late to set boundaries once the problem resurfaces.

 

Recovery from addiction is no different than any other chronic illness. There is no cure, per se, but the illness can be kept in remission indefinitely, one day at a time. No one ever has to relapse, and as long as your wife follows the directions she received in treatment, there’s no reason to think she ever will.
 

Rethinking Drinking

Here is a question we received that we answered in our regular newspaper article…

 

Dear Jeff and Debra,

I have a running argument with my spouse about my drinking and I want you to help settle it. I have one glass of wine every day and only one glass. Very occasionally, I will have another glass of wine when out to dinner with friends on the weekends. My spouse thinks I drink too much, but I think I’m very moderate. Do you think my drinking is too heavy?

Mr. Moderate

 

Dear Moderate,

One of the most important pieces of information we need to answer your question is missing, and it’s one of the most important reasons that people mistake “healthy” or moderate drinking for unhealthy or heavy drinking. The question is: What’s the size of a standard drink? Let’s look at the numbers supplied by the National Institute of Alcohol Abuse and Alcoholism (NIAAA).

 

The following drinks are considered equal in the volume of alcohol delivered to the human body. 12 oz of regular beer = 8-9 oz of malt liquor = 5 oz of table wine = 3-4 oz of fortified wine (such as sherry or port) = 2-3 oz of cordial, liqueur, or aperitif = 1.5 oz of brandy(a single jigger or shot) = 1.5 oz shot of 80-proof spirits (hard liquor).

 

In most social situations, alcoholic beverages aren’t carefully measured, so unless the drink comes in a single-serving container, like a can of beer, it may be unclear how many “drinks” are being served in a single glass. If you have a large goblet of wine and call it a single glass, it may easily contain two drinks, or 10 oz of wine.

For men, at-risk or heavy drinking is defined as more than 4 drinks on any day or 14 per week. So, if you exceed 4 drinks on a given day, you’ve crossed into heavy drinking. If you exceed 14 drinks in a single week, you have also crossed into heavy drinking, though you may never have had four drinks in a single day. For women, the numbers are smaller, both because women tend to weigh less than men and because they metabolize alcohol differently. For women, heavy drinking is defined as more than 3 drinks on any day or 7 per week.

 

The question for Mister Moderation is: How big is your glass? If you’re only having one 5 oz glass of wine per night, you’re not a heavy drinker. But, if you use a larger goblet, your drinking may put you at risk.

 

Some people say that light drinking may be good for your heart, but balance that potential benefit against the risks of heavy drinking. These risks include liver disease, heart disease, sleep disorders, depression, stroke, bleeding from the stomach, sexually transmitted infections from unsafe sex, and several types of cancer. Heavy drinkers may also have problems managing diabetes, high blood pressure, and other conditions. Birth defects are a risk with heavy drinking, as is the increased chance of injuries from a variety of accidents.

Quite a rouges gallery of risk for a potential benefit that can also be delivered by grape juice.

 

If you’d like to delve into this discussion more deeply, the NIAAA has developed a new website called Rethinking Drinking. It doesn’t focus on alcoholism, but rather the risks of heavy drinking. It will also show you how to assess your own drinking pattern. If needed, valuable tips are provided on cutting back, or on finding help if you can’t. http://rethinkingdrinking.niaaa.nih.gov/

 

Your question lacks a critical number, as we’ve explained, but it also contains an important piece of information that deserves a special comment. If your spouse believes that your drinking is problematic, listen to her. Whether or not she’s technically correct is beside the point. If the use of alcohol is damaging an important relationship, it’s already a problem. It’s often said among recovering alcoholics, “it’s not about how much you drink or how often you drink, it’s what happens to you when you drink.”

 

Perhaps you shouldn’t be counting drinks or measuring fluid ounces, at all. Instead, try asking yourself: “What’s so precious about this drink and what am I willing to sacrifice to have it?”