Archive for July, 2014

Teenage popularity: blessing or curse?

Jul. 29th 2014

Why affluent adolescents fail to launch

Being athletic, attractive, socially admired and sought after seem like the perfect solutions to overcoming the angst and insecurities common in the early teen years. It might feel as though you’ve dodged a bullet if your child is one of the popular kids, but watch out.

This temporary teenage high is more of a flash fire than a slow burn and many end up in “failing to launch” as adults.

Fast-forward a decade, and the once-popular kids are often struggling with substance abuse and low achievement, looking back on the glory days, with parents providing a helping hand for living expenses.

Popularity as a problem predictor

This might come as a surprise, but popularity is actually a better predictor of future problems than teen substance use itself, according to a study from the University of Virginia and discussed in Jan Hoffman’s New York Times article “Cool at 13, Adrift at 23”:

“Pseudomature behavior is even a stronger predictor of problems with drugs and alcohol than levels of drug use in early adolescence.”

But why? Why, when they seem to be on the road to success, does stable young-adulthood so often elude them? Let’s explore some answers.

Emotionally unprepared

Early stardom, hosting the all-nighter, and attaining “Queen Bee” status carry their own stressors.

“The teenagers who lead the social parade in middle school – determining everyone else’s choices in clothes, social media and even notebook colors – have a heavy burden for which they are not emotionally equipped.”

Once you’ve won the big game, become party central, or bedded that special somebody (probably following an over-the-top prom invitation), it’s hard to maintain the pace without raising the stakes to dangerous levels.

For me, playing left wing on varsity in eighth grade and winning the big game at 15 were incredible highs. So was beating the competition for class rank and making it into an Ivy League college. But that euphoria passes quickly, and it’s easy to turn to alcohol in an attempt to recapture the endorphin rush.

Most young teens lack the perspective and sophistication to handle early peak experiences. It overwhelms them, even as they pretend that everything is under control. It’s not easy feeling insecure on the inside while presenting a bulletproof exterior to fend off the competition at any age, let alone at 16.

Early success and attention can be scary – and there’s no one to talk about it with because most adults think success breeds happiness. Under the guidance of aware adults or a strong internal compass, some maintain self-discipline until their brain develops abstract concepts and they gain a perspective on their experiences, but this is more the exception than the rule.

There’s only one Missy Franklin for every 10 Justin Biebers.

The lifestyle

Being “special” is an especially well-trodden path for children of affluence. Kids who come from families with money – who have the trendiest name-brand clothes, the latest technology, the fastest cars, etc. – often find themselves at the epicenter of their social circles. Their peers want to be around them; they’re put on the A-team in athletics; teachers and administrators buckle under the weight of the family’s prominence. Out here in the Land of 10,000 Lakes – these are the Boat People – kids with lake homes who drive jet skis and migrate to houses with absent parents and accessible alcohol.

Some skate through – never pushed to build real-world, employment-worthy skills. Others are on the track for high-prestige schools and run into trouble post-college.

Athletics

For the budding athlete, there are varsity induction rituals like hazing and end-of-season celebrations – all of which involve heavy drinking. Prowess on the field and in the gym creates a sense of invincibility and many opportunities for binging. This includes girls, ever eager to show they can outshine the boys.

With winking disapproval from administrators and parents, the relationship with alcohol (and eventually other drugs) becomes ritualized.

Dubious role models

The attractive, the good-looking, and the superficially sophisticated not only look up to older role models as trendsetters but are often partying with high-status students three to four years older. And it’s usually the more exploitative elders who are interested in the younger crowd. Some juniors and seniors get off on introducing the underclassmen (particularly girls) to alcohol, drugs, and of course sex. It’s a game for them, and they don’t care who gets hurt.

‘Best friend’ parents

Many upwardly-mobile parents are pleased their sons and daughters are tight with the in-crowd and overlook the danger signs, including their own inability to see how they are living vicariously through their children.

Large houses with absent or benign-neglect parents become party central. Many parents would rather have their kids use at home than drink and drive, so there’s a lot of “staying over” for the night at a friend’s house and arriving home at noon the next morning. Moms call school with excuses for missing homework and postponed exams.

Does this sound familiar? If so, you are courting big trouble.

Affluent young adults and substance use disorders

Many are surprised to hear that over 20 percent of affluent young adults assess as needing substance use treatment. Our teens under discussion here comprise a good portion of this group.

It’s a simple but vicious cycle for the affluent:

  • Their kids are the popular kids.
  • The popular kids are the kids who grow up too fast and with few limits.
  • The kids who grow up too fast are the kids who end up needing alcohol and drug treatment.

(Most of the remainder are college students with genetic histories of addiction in their families who party hearty in college and trigger their gene.)

Not cool anymore

As these kids age up into their twenties, they think that these “pseudomature” activities will help them maintain their position, but in reality they inhibit true maturation. They get stuck living in their middle-school world, their emotional and intellectual growth stunted by alcohol and drug use. While they’re acting grown-up, their “less-cool” peers are actually growing up – and passing them by.

They are doing more extreme things to try to act cool, bragging about drinking three six-packs on a Saturday night, and their peers are thinking, ‘These kids are not socially competent,’ ” Dr. Allen said. “They’re still living in their middle-school world.”

Yes, getting wasted at 24 at the family compound with buddies is no longer just “having a little fun.” Unlimited access to alcohol and drugs with few consequences begins to take its toll – a bitter irony for parents, as the very things they aspired to for their kids sowed the seeds for future dysfunction.

Individuality and confidence

This is one of those situations where the risks associated with popularity and higher socioeconomic status can sink your child. However, this all-too-familiar ending is by no means inevitable. But it takes parents who are really on their game – stars in their own right – who understand the dangers being overinvested in their children’s successes, particularly as surrogates for their own unfulfilled dreams. These parents can help their preteens and teens understand and accept that popularity isn’t the end-all be-all.

“Parents can reinforce qualities that will help them withstand the pressure to be too cool, too fast. … Adolescents who can stick to their own values can still be considered cool, even without doing what others are doing.”

One key task is to keep the dialogue going on how your child feels about being the center of attention. That means taking the time available when your child wants to talk, not when you want to talk. And be a parent – not a friend or cheerleader.

  • Look out for pseudomature behavior and bad-influence older friends.
  • Provide structure and accountability.
  • Homework first.
  • No overnights.
  • Don’t allow the demands of practice and friends to override family time.

It will likely put a dent in your child’s popularity, but far better to suffer through a few teen years in the middle of the pack than all of adulthood in stunted adolescence.

One lawyer joke too many

Jul. 29th 2014

No more room for the actively impaired attorney

Lawyer addiction rates are twice the national average

Estimates suggest that attorneys, judges, and law students struggle with addiction at roughly twice the national average; as many as one in five lawyers has an active addiction problem; and it gets worse the longer they practice. Rates are also much higher for both depression and suicide.

These are powerful and eye-opening numbers to be sure, clearly demonstrating the need for proactive efforts and resources to reduce the prevalence of active behavioral health issues in the profession. Profound consequences — both subtle and explicit — impact firms every day.

As an attorney/addiction clinician in recovery, I have worked to help solve this crisis. Addiction is a chronic disease, and law firms must confront it accordingly.

The tangible risk to the firm is documented

Despite the fact that they may be under-serving clients, losing energy and focus, becoming more erratic and less reliable, lawyers typically plow forward until the consequences become too severe to be tolerated. Often the line is crossed into malpractice and disciplinary problems:

60 percent of all disciplinary actions and 85 percent of trust fund violations are connected to addictive behavior.

Even with these risks staring them in the face, firm administrators and managing partners fail to confront problematic behavior indicative of an underlying behavioral health disease or condition. It is easy for the rest of the firm to follow suit, believing that it is not their business and quietly looking the other way. This approach has a long and entrenched history in a culture already imbued with a play-hard, work-hard ethos.

The damage to the firm of ignoring these problems is incalculable

I will write about this subject in more detail in the future, but suffice it to say that these problems predictably become worse without treatment, until the attorney and the firm suffer untold damage. Reputations are destroyed, productivity is decreased (every single day), lawyers — particularly lateral hires who often have their own existing issues — leave, retire early, or implode; clients leave; and the firm’s chemistry and investment in talent evaporates.

If it’s good enough for doctors, it’s good enough for attorneys

Most lawyers are unaware that doctors and pilots have very high success rates for recovery from addiction. Their programs are different than those for the general public, including attorneys.

 

  • Physicians: 74 percent continuous sobriety at five years
  • Pilots: 92 percent continuous sobriety at two years

 

Addiction is the only field of medicine where doctors receive different treatment than the general population. If the same success rates applied to cancer treatment with differential outcomes, there would be massive lawsuits — but not for addiction treatment.

These groundbreaking rates of success can inspire firms to commit to learning about these programs and how to apply the same protocols to their lawyers, staff, clients, and families.

Achieving high recovery rates for addicted attorneys

As the founder of the Hazelden Legal Professionals Program (and director until this past January), I am committed to educating firms and lawyers in order to destroy the stigma standing in the way of seeking treatment. And more importantly, implementing the physician/pilot model as the template for establishing stable recovery and return to the firm.

We can and must do a much better job of protecting our profession and those of us who serve it.

Posted by Link Christin | in Addiction, Lawyers, Lawyers' Link to Recovery | No Comments »

Recovery coaches

Jul. 16th 2014

A powerful resource in attaining stable sobriety

We have long recognized recovery coaching as a critical component in sustaining the gains made in treatment when a family member returns home after an inpatient stay.

Coaches perform a wide range of services, from assuring clients attend therapy appointments to homestays as sober companions. 

But most importantly, for recovering addicts, having the always-available, empathetic, and supportive ear of someone who is committed to their success can make all the difference in achieving a substance-free life.

In our work on behalf of families, we often include a recovery coach as part of the overall post-treatment recovery plan, along with a case manager, therapist, addiction-certified psychiatrist, and drug-testing monitor. They not only support the person in recovery but act as liaison to the case manager and family.

But now coaches are playing a new role, hired by people who want to sober up without going to inpatient treatment.

With growing self-awareness as to when drinking or prescription drug use is out of control, many are now taking action on their own to avoid major problems down the road.

Inpatient treatment not an option

A recent article in The New York Times, “A Guide’s Sobering Effect,” discusses how affluent mothers are hiring coaches as part of their efforts to stop using and stay clean.

Why this alternative to going to rehab?

  • Work demands preclude time away.
  • Fear of losing their children if they go inpatient for 28 days.
  • Reliable support to attend meetings and appointments.
  • Privacy (A.A. members gossip).
  • Protection of reputation (there still is a double standard re: women addicts).
  • Avoid building a medical or insurance record.
  • Relapse prevention after inpatient or outpatient treatment.

In short, recovery companions are “more anonymous than A.A.” and can seamlessly blend into social and professional circles, sometimes as administrative assistants, trainers, or friends.

Challenges in early recovery: thoughts, feelings, behaviors and STRESS

In early recovery, having a companion can help manage addictive thoughts, feelings, and behaviors. Here are three excerpts from the article:

  • “It’s not the actual substance that defines addiction, it’s the feelings underneath.”
  • “Addiction is a disease of isolation.”
  • “She taught me to write my feelings down and think things through instead of heading down the path of destructive impulses to quiet down the white noise in my head.”

An empathetic approach, guidance, and role modeling help create a positive attitude in the client and the hope that the future will be better without drugs and alcohol.

Predictors of recovery

Data shows that addressing the emotional side of recovery supports long-term abstinence. This includes:

  • Building coping skills for stress and relapse-inducing situations.
  • Identifying situations with potential for relapse. (Men report positive feelings prior to relapse, women negative emotions and interactions.)
  • Managing the environmental cues (people, places, and things) that trigger the desire to use.
  • Resisting declining motivation after inpatient treatment.
  • Helping resume normal activities within recovery and still maintaining balance.
  • Managing stress.
  • Upholding a commitment to abstinence.
  • For at least six months after treatment, attending recovery activities, limiting workload and social activities, and avoiding stressful situations.

Coaches help their clients with all of the above, which is why they are key to improving recovery rates and why we find them so valuable in our work with families.

Level of service varies

And it’s hardly a one-size-fits-all approach. The person in recovery (or the family) can choose the level of service – from once-a-day check-ins and weekly visits to 24-hour live-in company (no, they are not nannies). We see coaches play many different roles:

  • responding rapidly to client needs,
  • offering intensive support,
  • stabilizing individuals in crises,
  • helping fight the day-to-day urges,
  • handling logistics,
  • accompanying the individual through potentially stressful and unsafe situations, and
  • acting as intermediaries with family member.

Recovery companions provide both the oversight and the peer support integral to long-term success. They work collaboratively with treatment teams and are closely supervised.

Qualifications

What do we look for in a coach?

  1. At least five years in active recovery, vetted with background checks, and solid references. (Some recovery services will staff a recovery companion with six months or less of sobriety.)
  2. More skills than having just gone through A.A. themselves – they need to be trained in relevant educational fields.
  3. Appropriate boundaries. This is perhaps most important, as we don’t want the coach borrowing money, etc. That is one reason why they need to be well-compensated. Not only is the job demanding, but good pay reinforces the professional relationship.
  4. The coach also should have a supervisor or other professional s/he is accountable to. In other words, s/he should work for an organization either as an employee or independent contractor for oversight purposes.

Our take

It’s terrific that these women are developing a new approach to getting off alcohol and drugs – one that allows them to remain in the community and become sober. In our work with clients we find that recovery coaches are invaluable resources for sustaining abstention. They tell us what’s going on with the family member in recovery and are the first to know when there is a potential or actual relapse.

So when thinking about substance use disorder treatment, keep in mind what happens after leaving rehab and the benefits of recovery coaches.

For more information on how coaching/companion services fit into an overall post-treatment plan to improve recovery rates, check out our article, “Case Management for Families Dealing with Addiction Recovery: Dual-Track Method.”

Iron Man Robert Downey Jr.

Jul. 7th 2014

A parent who gets it and a hero in real life

It’s hardly surprising anymore when the children of celebrities and the wealthy end up in trouble with drugs and alcohol. No one bats an eye when seeing celeb scions cruise through their private high schools while spending nights barhopping and partying with seemingly few restraints. People – their peers and elders alike – cater to their every whim, in the hopes that proximity to money and fame will rub off.

A matter of time

For those of us growing up in families of means and prominence with a history of addiction, it’s often just a matter of time before we, too, go over the edge into substance dependence. Once there, our resources and connections allow us to avoid the consequences of our binging and being high on the town. Yet it is exactly these consequences that help us break through the delusion that our using is “normal.”

Go to great lengths

In our work with families, we see parents go to great lengths to protect their children’s academic and police records from indications of substance use.

 

  • They offer lip service to counselor recommendations.
  • High-priced attorneys work the legal system.
  • Well-timed donations smooth over any school policy violations.

 
This teaches the child that their parents will bail them out of any trouble, so party on.

The end result is often a son or daughter in their mid-twenties, dependent on family money, with limited skills and a not-so-well-hidden persistent booze or drug problem. Perhaps there is also a failed effort at moderation drinking or treatment. And now the substance use disorder has gone from mild to moderate, or even severe, and the parents have a potential chronic user on their hands. Not only has their child wasted an education and all the money that went into it, but they also face more multiple thousands in future treatment costs.

A hero in real life

Into this scenario walks Iron Man actor and our hero in real life: Robert Downey, Jr., who was recently named in the top 10 of Forbes’ Celebrity 100 after battling addiction for most of the ’90s. When his 20-year-old son, Indio, was arrested for cocaine possession, Downey, Jr. said:

“We’re grateful to the Sheriff’s Department of their intervention and believe Indio can be another recovery success story instead of a cautionary tale … Unfortunately there’s a genetic component to addiction, and Indio has likely inherited it.”

Downey, Jr. did everything right:

  • No excuses.
  • No claiming the coke belonged to someone else in the car.
  • No saying it was an isolated incident.
  • No going to a Malibu spa resort (a.k.a. treatment).

Indio’s dad came forward and said what I wish so many dads would say: that addiction is in the family and it’s a problem we have to deal with now.

The arrest becomes the opportunity for engaging Indio in a discussion about his use and getting help, as well as therapeutic leverage, to encourage compliance with treatment recommendations.

Preserving their image

Unfortunately, most dads are too committed to preserving their social standing and false image of their child or too busy to deal with family conflict. Instead of using the arrest as a focal point for assessing the extent of use and pressure for treatment, the opportunity is lost.

They just want it all to go away, but it usually does not.

(And this is often the start of a family war, because Mom wants to do more and Dad is adamantly against her ideas – or vice versa.) 

Write our own endings

“Robert Downey, Jr.’s son may be following his father’s dark path.” – That’s what the New York Daily News said.

But no, he is not. It’s a different path – his family has said so.

The general public envies and emulates the high-end life style of the rich and famous without also acknowledging that it is precisely these privileges that put this population at very high risk for addiction. When the inevitable happens, a social media feeding frenzy ensues, accompanied by moralistic banter.

For affluent young adults from prominent families, power and access to money offers intensified life experiences from a very early age. Going down that path can easily trigger the gene of addiction, as in Indio Downey’s case.

That is our reality that we own and recognize as a duality: the benefits and obstacles of being born into addicted family systems with money. 

But it’s our story – not the media’s – and we can write our own endings.