Archive for the 'From the headlines' Category

Recovering out loud

Jan. 13th 2016

Jeb Bush sets the standard for facing addiction

In your family as in mine, did side conversations occur during the holidays about cousins, in-laws or next-gens in rehab, relapsing or actively using? How about relatives or offspring of family friends fresh out of treatment – are they back at it? Of course these are all very quiet discussions; don’t tell anyone.

 

We don’t want to talk about it, do we? 

 

But Jeb Bush does. 

 

As a father, I have felt the heartbreak of drug abuse. My daughter Noelle suffered from addiction, and like many parents facing similar situations, her mom and I struggled too.

 

I never expected to see my precious daughter in jail. It wasn’t easy, and it became very public when I was Governor of Florida, making things even more difficult for Noelle. She went through hell, so did her mom, and so did I.

 

It’s very debilitating when you have a loved one who is struggling, and you can’t control it. You have to love them, but you also have to make it clear you cannot enable the behavior that gets them in trouble.

 

Showing a lot of courage, Noelle graduated from drug court. Drug courts use a restorative solution model involving multi-disciplinary coordination, including the judiciary, the prosecution, mental health specialists, social services and treatment professionals. I was the proud dad that saw Noelle finish that. She’s drug-free now.

 

Noelle was charged with forging a fraudulent prescription for Xanax and with possession of crack cocaine. Her parents chose not to use their influence to get her off. They were smart enough to realize that criminal charges could be used to force her into multi-disciplinary treatment with accountability for clean drug screens over many months – the proven formula for successful recovery.

 

Hearing from parents like Jeb helps us understand how Noelle recovered and “normalizes” addiction – making it just like any other illness. Unfortunately, most families aren’t as forthcoming as the Bushes and few follow through to see that consequences remain in place.

 

Common rationalizations counterproductive to achieving long-term recovery (and my responses) include:

  • It’s up to the addict to tell people. (But if s/he never does tell, people can’t be supportive.)
  • Let’s keep it a secret. (But addiction thrives in secrecy and withers in openness.)
  • I am ashamed to have an addict in the family. (But addiction is a disease. Is it shameful to have cancer?)
  • I need to let go. (But addicts need accountability. If not you, who will hold them accountable?)
  • I would never suggest alcohol/drug testing. (But testing leads to improve outcomes and early intervention in case of relapse.)

Facing addiction means talking about substance use and abuse and recognizing it is a chronic disease that can be prevented or minimized if families and their advisors work together. For most, however, even simple steps, like attempting to estimate the percentage of substance abusers or others with significant behavioral health disorders within the family, is fraught with controversy and rarely undertaken. And what is the tipping point – 20%, 30%? – sufficient to motivate action? In my family of origin, combining my parents, grandparents and siblings, our rate is over 50%. That’s 911 time in my book – and one reason I became a licensed alcohol and drug counselor.

 

Doing nothing or ignoring it is not a successful strategy and only leads to tragedy. It takes a village and thoughtful planning – before you find yourself in crisis – to have a chance against the power of the drug or the drink.

 

When parents talk openly about their experience, other families learn about what works for recovery. And their stories serve as cautionary tales for those in their teens and twenties.

 

Until we find the courage to move beyond our shame and our silence about addiction, unneeded relapse and avoidable deaths will continue to happen.

Worse than ever: Pain pills and heroin use

Apr. 28th 2015

More people are dying from opioid overdoses than traffic accidents, yet no one seems to notice or want to address it. As commented on in the April 17th issue of The New York Times, “Serving All Your Heroin Needs”:

 

Meanwhile, the victims – mostly white, well-off and often young – are mourned in silence, because their parents are loath to talk publicly about how a cheerleader daughter hooked for dope, or their once-star athlete son overdosed in a fast-food restaurant bathroom.

 

Look at the numbers: 24,000 deaths from opioids. While the pain pill machine goes about its business of producing more and more addicts, no one says a thing.

 

For parents who do stand up and speak, the response is underwhelming. I attended an event at a large suburban high school billed as a community forum to examine the problems of recreational drug use, prompted by the drug death of a 17-year-old. Her father, Tom, spoke very movingly and passionately about his loss, but the audience was almost devoid of parents.

 

Why? Is it fear of hearing a contemporary bare his soul about a parent’s worse nightmare? Is it hoping that ignoring the problem will make it go away – soon they’ll be off to college anyway? Who knows? But the absence of any passion – any demand for action – was striking.

Stimulant use among 26-to-34-year-olds doubles in four years

The Sunday Times had a second story, this one on abuse of ADHD medications, titled “Workers Seeking Productivity in a Pill are Abusing A.D.H.D. Drugs.” Stimulants like Adderall, Vyvanse, and Concerta are migrating from school settings to the workplace. They’re now in play in demanding professions:

 

These lawyers said they and dozens of young colleagues at their firms had casually traded pills to work into the night and billed hundreds of extra hours a year in the race for partnerships.

 

Overuse leads to rapid heartbeat, acute anxiety, hallucinations, sleep deprivation, and addiction. Just the type of professional you want working on your case or in your firm or client base. Outside of the workplace, these pills are “Mommy Crack,” great for staying thin and multitasking on the home front.

 

Again, this phenomenon starts in high school, where students sell pills or give them to friends to help with academic focus and performance. They’re great for answering the four or five extra SAT questions needed to break 700 and pulling all-nighters for studying and exams. Whether it be weed, alcohol, uppers, or downer, students in every high school know who is selling or providing drugs and drinks, but are unwilling to name names out of fear of being ostracized or to protect their sources.

Silence and indifference

In any case – at the parent or student level – we have created a culture of silence and indifference not seen since the AIDS epidemic. We are beginning to make the connection between binge drinking and date rape among high school and college students, but a similar connection must be made between pharmaceutical companies’ and doctors’ profits and drug dependence and deaths. In both instances, the big businesses supplying the alcohol and pills pay less than 5% of their collateral damage and can never atone for their increasing death toll.

 

Not to minimize the AIDS epidemic, but what we’re dealing with here is on a very large scale. The Band Plays On, with alcohol and opioid deaths exceeding 100,000 per year. When will enough of us join together to stop this growing tragedy?

Becoming addicted to pain pills

Perhaps understanding how opioid dependency develops will be the first step in generating more public support for taking on the drug industry.

 

For those of you unfamiliar with how someone becomes dependent on pain pills, here is how it happens. People have an injury, surgery, or dental work and are given a prescription for 30 pain pills. After just a few days, it takes more pills to obtain the same level of effect in dampening pain. Most patients learn to tolerate their pain and supplement with over-the-counter medications. But then once they near the end of their supply, there is the problem of stopping. Stopping abruptly leads to uncomfortable physical symptoms, so most people taper off. But addicts are not like most people, and they don’t stop.

 

The dependency cycle

 

The dependency cycle begins when a person ups the dose, decides it’s too uncomfortable to quit, or in fact likes the physical and psychological effects from the pills. These narcotics can give a euphoric sensation of withdrawing from the world. Users will continue to seek prescriptions until their doctors decide to cut them off. From there, they turn to doctor-shopping and online ordering, or worse.

 

Switch to heroin

 

Many users – or addicts – switch to heroin because it’s cheaper and more readily available. It also can produce a really powerful and pleasurable body jolt the first few times. This motivates the addict to “chase the high” – trying to reproduce the feelings from that first time by increasing the amount, potency, or by mixing with other drugs. Very dangerous and a big reason for all the deaths. A similar process occurs for other narcotics.

 

Over-prescribing

 

Painkillers are meant for acute pain, not chronic pain, as are most other drugs, such as anxiety or sleeping medications. But remember, this starts with the doctor handing out the initial 30-pill prescriptions or samples provided by Big Pharma, enough to hook some patients, as the drug companies know all too well. And it’s no secret that doctors are liberal with the scripts – even doling out Norco (acetaminophen and hydrocodone) by the handful to newly-postpartum nursing mothers. It’s hard to keep saying no when it’s always offered.

Transforming public opinion and policy

Attacking the supply side seems like a good first step, but that means overcoming deeply entrenched social stigma, leaving the shadows, and finding the courage to tell our truths – namely that these problems don’t exist in a vacuum. With opioid-related overdose deaths occurring every four minutes, we can no longer pretend that these “dirty” deaths are only happening to strung-out junkies living on the streets in the inner city. They are happening to us, our families, and our friends. Fortunately, new generations are stepping forward to start conversations aimed at transforming public opinion and policy.

To Tom, the father who spoke out at the community forum, you are not alone, and we will not forget your daughter.

Moderate drinking: A destination or way station on the road to abstention?

Apr. 7th 2015

My comments on “The False Gospel of Alcoholics Anonymous” in The Atlantic

Gabrielle Glaser’s lengthy article in the April 2015 issue of The Atlantic, “The False Gospel of Alcoholics Anonymous,” (online as “The Irrationality of Alcoholics Anonymous“) is something of a misnomer, as its focus is on the failings of the treatment industry as a whole, including over-reliance on AA’s 12 Steps, interspersed with anecdotes from people interested in reducing or moderating their drinking. The dramatic tension in the article is between abstinence-based models (AA and inpatient treatment) and harm-reduction or controlled drinking models for people who may or may not meet DSM-V diagnostic criteria for alcohol dependence.

 

This is a common theme that crops up regularly in the media and is promoted heavily on the web – alternatives to AA that either teach people how to drink “normally” or offer narcotic medications as alcohol substitutes. While Glaser identifies several valid criticisms of the current system, the author’s focus is on promoting alternatives to abstention for people who very likely should be putting the cork in the bottle and leaving it there.

 

Here’s my quick take:

 

Moderation/Experimentation

Moderation/experimentation can be useful if there is an adequate assessment process (including drug testing and input from family members) and accountability in the event of failure. Unfortunately, Glaser overstates its benefits and understates its risks. In my view, it’s never appropriate for drinkers with severe disorders or co-occuring mental health concerns.

 

Drugs

We need to be clear what kind of drugs we’re talking about here. Drugs such as naltrexone that are not cross-addicting (unlike, say, Valium) can be helpful to some people in reducing their drinking or abstaining and are available at many treatment centers. But replacing addiction to alcohol with addiction to benzodiazepines should not be considered a success.

 

Treatment outcomes

In terms of recovery rates, programs for pilots and doctors have far superior outcomes to all other programs, and we should be talking about implementing their programs for all. Arguing about AA success rates and other treatment models for which there’s no data seems at best subjective, at worst pointless.

 

Alternatives to AA

Yes! Patients/clients should be offered material without references to God so they can participate in treatment center activities with their peer group. They should also be offered alternatives to AA meetings, such as Smart Recovery and Women in Sobriety. But let’s not forget that AA (and 12-Step programs) has worked wonders for a lot of people; there’s no need to completely trash it out. Additionally, from what I’ve seen, the article exaggerates AA’s role in most treatment programs.

 

Range of options in community-based settings

In an ideal world, a patient’s learning skills and preferences would be matched with a menu of treatment resources. With the ACA, many more options are in place, including groups for people who are thinking about stopping drinking. For example, in my hometown, two miles down the road from Dr. Willenbring’s office, Hazelden is building a brand new outpatient megamall. The one-size-fits-all criticism is now outdated in many communities.

A framework for evaluating addictive behavior

Whenever information is presented about someone with an apparent addiction, it’s important to understand the framework used to diagnose and assess the concern. My approach is grounded in medically-based information on the effect of alcohol or drugs on the brain, the American Psychiatric Association DSM-V Diagnostic Manual, and an evidence- or facts-based evaluation model, including drug testing.

The starting point for evaluating articles about drinkers or drug addicts

The starting point for sorting through these advocacy pieces, then, is the disease model for substance use disorders and contemporary “best practices” as applied to the four anonymous prototypes in the article: 

  • G. who used to drink a liter of Jameson a day but now does not drink and is taking Baclofen and Valium, as needed for anxiety.
  • Claudia who takes naltrexone and now stops at one drink.
  • Jean who was drinking a bottle of red wine a day and now has an occasional drink.
  • P who had as many as 20 drinks at one time, and by using naltrexone binges two or three times a month.

Brain changes due to drinking

Consistent with the mainstream medical perspective, the article reports that addiction results from changes in brain structure due to long-term excessive drinking:

 

Each time [a person drinks] the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive. (p. 55)

 

While alterations in the brain can be seen through imaging, scans are expensive and not usually used in the diagnostic process. Instead, the American Psychiatric Association has developed 11 diagnostic criteria to assess the degree of substance dependence (brain alteration) in the DSM-V.

The DSM-V

The DSM-V assessment process uses 11 criteria with three levels of dependence based on symptomology: Severe (6+), Moderate (4-5) or Mild (2-3) alcohol use disorder. Keep these in mind when thinking about controlled drinking, for as the article reports:

 

Moderate drinking is not a possibility for every patient, and [Dr. Willingbring] weighs many factors when deciding to recommend lifelong abstinence. He is very unlikely to consider moderation as a goal for patients with a severe alcohol-use disorder. … Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or lack of social support.

 

The idea being that if the brain is altered sufficiently, it’s almost impossible to regain control at the 6+ level. These people are candidates for stop-drinking programs, whereas the moderate and mild drinkers are said to be appropriate for the doctor’s managed-drinking program using naltrexone.

Substance use diagnosis first, please

The first question anyone, including writers, should ask our four prototypes is:

 

What’s your DSM diagnosis? And then, what’s your status regarding related co-occurring disorders?

 

Current thinking is that people with a mild diagnosis may be able to control their drinking because their brains have not crossed the threshold to permanent alteration. However, people in the moderate category may not be able to consistently regain control, which brings up the harm-reduction/moderation debate in the treatment profession.

Harm reduction

We all know people who meet the moderate/severe category and want to continue drinking. P, for example, is using naltrexone to cut his binging down to three times a month. This type of harm reduction is viewed as a “win.”

  • However, for people like P, who meet the severe or moderate criteria, the risk is that they can revert to their old patterns, drink and drive, or hurt their family members.

Even with reduced drinking, they may still retain the emotional disorders associated with greater use (i.e., the dry drunk). Harm reduction then becomes a tolerated permanent status rather than a stopover on the way to abstention. Maybe not such a great win for P’s liver, spouse, children, or employer. But who knows?

Cross-addiction

J.G., who is now “not drinking,” is prescribed Valium for his anxiety. Anyone in the treatment field knows Valium is commonly used for alcohol detoxification because it hits many of the same brain receptors. It’s alcohol in a pill form and often used in place of alcohol by people who “don’t drink at all.” It’s odorless and easy to obtain over the Internet or through doctor shopping.

 

Replacing alcohol with Valium is simply substituting one addictive substance for another and is not considered abstinence as defined in the DSM-V or mainstream addiction medicine. But there are doctors and treatment centers that prescribe benzodiazepines (like Valium) to people with substance use disorders and claim their patients are in recovery – on maintenance therapy.

 

The author goes very light on this topic and does not even mention the very real possibility of cross-addiction. She also fails to note that Baclofen is associated with significant withdrawal symptoms and cautionary side effects and is in need of further study for use in treating alcoholism.

Addiction-certified doctors

The Valium script issue highlights the need for training on addiction in the medical profession. However, the number cited, 582, is incorrect, as there are over 300,000 members of the American Society of Addiction Medicine (ASAM), according to its website. With more addiction-savvy doctors, fewer patients will be prescribed benzos to help them control their drinking.

Assessment information: corroboration and BAC levels

One problem omitted from the article is the difficulty of assessing alcohol use when drinkers self-report in the absence of outside verification from family and friends or drug tests. Without such a system in place, moderation and experimentation can easily be a cover for continued excessive drinking and using. (For example, courts in Minnesota require three collateral sources.) “Trust but verify” through corroboration and random, supervised testing is state-of-the-art these days and would aid in determining whether Jean and Claudia meet the moderate, mild, or no diagnostic standard.

Experimentation/Controlled drinking

Drinkers in the moderate and mild category are said to be candidates for experimentation with or without the aid of naltrexone. By helping clients set behavioral expectations and then reviewing progress in meeting their goals, counselors can play a key role in building awareness regarding negative use patterns. This approach works particularly well with young adults.

 

This kind of “experimentation,” as discussed in the article, where people see if they can stop for a time, drink less, or drink on fewer occasions can be a good learning experience, as the author points out. It helps in breaking through the self-perception hurdle – over 90 percent of people with addictive disorder issues do not perceive themselves as having a problem – and it increases willingness to seek additional help when goals are not met.

 

As Glaser points out, these techniques, including prescribing Naloxone, should be part of the repertoire of outpatient clinics and individual addiction counselors these days. And, since most people who drink excessively are not alcohol dependent, an evaluation process is preferable to going directly to inpatient treatment, as can happen in the surprise intervention model.

Experimentation, to what end?

In my experience, people who “experiment” and fail don’t usually decide to increase their level or intensity of treatment, unless there is a written agreement in place or there is pressure from family or an income source (e.g., a trust or employer). In other words, insight alone is often insufficient to induce behavior change.

 

This leads to another concern: People don’t have alcohol and drug problems in isolation. It’s a family/community problem, and this larger group’s interests and opinions need to be taken into account as to how long they are willing to tolerate “failed experimentation.”

Treatment

When the topic of treatment effectiveness is raised, my starting points are the highly successful programs run by airlines for pilots and medical boards for doctors.

Outcomes – Best practices

The programs for physicians and pilots have proven outcomes of 74 percent continuous abstinence at five years and 92 percent at two years. Proven because the participants are drug tested over that time period. No other programs match these outcomes. The real criticism of the treatment industry should be its failure to apply the physician/pilot programs to all groups.

Treatment compliance/effectiveness

Patient failure to comply with treatment recommendations is a major cause of relapse. Is this due to lack of programs that appeal to clients? The system lacks incentives to encourage compliance? Or is alcoholism simply very difficult to recover from?

 

For the author, it’s lack of appealing programming. From my view, it’s lack of incentive-based contingency management approach. Reward systems can be very effective in treating even hardcore crack smokers. Again, its common knowledge that the medical boards and airlines (also DUI/drug courts) use therapeutic leverage to encourage treatment compliance, but this approach and these state-of-the-art programs are never mentioned.

$35 billion a year on substance abuse treatment – we need better outcomes

This is one theme of the article: What are we getting for all this money?

 

The better question is why aren’t treatment centers adopting the pilot/physician model for all patients? The long answer is that inpatient treatment centers tend to be their own program and economic entities. Until they are held accountable for outcomes, they will have little reason to ensure quality, patient-centered options exist in the pre- and post-treatment environment. Again, the ACA appears to be creating incentives for accountability.

Inpatient treatment

J.G. says he went to a center where they offered little more than AA. Being from St. Paul, I am not certain what place he is referring to. It is clearly not a Minnesota Model treatment center like Hazelden, which offers a full range of modalities, including CBT therapy, acupuncture, meditation, education on the disease concept, groups, and mental health-related services (by the way, it also offers naltrexone for craving reduction). He might have attended The Retreat, an AA-only program located in Wayzata, Minn.

Treatment centers promotion of AA and alternatives

Inpatient treatment centers provide a variety of programming during the day (see above), but their residences are organized on the basis of self-regulated peer groups, usually around the principles of AA. Patients are also asked to participate in actual AA meetings. That can be a problem for people who don’t like AA or the God part. Some, like me, join in, as it seems to help and is benign. Others object.

 

Treatment centers should adjust their programming to meet the needs of their patients, rather than vice versa. It is possible to modify the 12 Steps and peer-based activities to eliminate references to God so patients have a choice when participating in group activities. Offering alternatives to AA, such as Smart Recovery and Women for Sobriety, makes sense as well, although it requires staff that is sufficiently talented to oversee and help implement these support groups as an AA alternative.

Post-treatment referrals

To clarify, patients are referred to a range of post-treatment resources, including AA meetings. These include therapy and outpatient or aftercare support groups. Some people who don’t like attending AA only go to their non-AA activities.

 

As noted in the article, the quality and content of AA programs vary greatly. In my experience, AA works pretty well for middle- and higher-income males, but not for others (e.g., minorities, women, LGBT, the affluent, and the poor) who fare better in more targeted groups. But only a few of these specialized groups exist. I agree that clients leaving treatment should be offered options to referrals to AA.

A range of evidence-based options needs to be offered people seeking help

In an ideal world, a patient’s learning skills and preferences would be matched with treatment resources. The treatment profession is heading in that direction. Until the enactment of the ACA and Wellstone parity implementation, insurance companies underfunded non-residential services. But that is now changing for the better.

AA concepts originally for chronic, severe drinkers, or not?

The in-depth historical analysis in the article helps the reader understand why the 12 Steps of AA are so prevalent in treatment today and why abstention is the only recommendation for those who are “truly” alcoholic. From this analysis, the author argues that AA is a one-size-fits-all program and inappropriate for those with less severe patterns of drinking.

 

Having interned at a treatment center, I know that staff can use a generic approach for everyone, without regard to their individual circumstances. However, the Big Book is more flexible and in fact has a set of stories entitled “They Stopped in Time,” describing how people came into recovery before they hit bottom. Many drinkers seek help with moderate use disorders and find the Big Book and 12-Step model useful in becoming sober. It’s all in how you approach it – open-minded or closed-minded.

Lack of trained, well-educated staff

Unfortunately, rigidity in implementation occurs because it is so often based on the personal opinions of staff in recovery and AA volunteers. It is this off-putting attitude that is so offensive to many people, like Jean in the article, who then recoils from what might be helpful concepts. It also highlights the lack of professionalism in treatment centers – another valid comment.

AA’s value

AA’s value lies in providing a support group for people with a common problem: how to stop drinking and stay stopped. AA focuses on the present moment – today – versus remorse over the past and anxiety over the future; shame reduction; emphasizing the disease concept; and being accepted for “who you are.” AA also provides a relationship network so people can share personal stories, make connections and feel better. As to the latter point, we now know that intimate group-sharing releases positive endorphins. These are valuable, if not critical elements, in sustaining long-term recovery, which the author overlooks in her critique of AA.

Addiction as a “good habit gone bad”

In his book The Power of Habit, Charles Duhigg explains that habits are formed over time and based on rewards from engaging in specific behaviors. Due to changes in brain structure from long-term excessive drinking, alcoholics respond to craving by drinking, and their reward is the alcoholic buzz. To stop this compulsive behavior, mainstream treatment is designed to teach new, healthy responses to cravings and new rewards. (This, by way, is the also the core function of AA.)

 

The tension between the moderation model and abstinence model has to do with the different responses to stimulus and the reward.

  • Drinkers practicing moderation remain in the same stimulus-reward system where they want to take a drink with the resulting effect on their body and emotions (but with craving synapses hopefully dampened through naltrexone).
  • In contrast, those of us in the abstention model learn an alternative response to picking up a drink – say exercising, with the reward being increased self-esteem or an exercise-induced increase in endorphins.

Abstaining usually involves “transformational change,” in that the person no longer believes alcohol is necessary to live and adopts a new value system.

Preparing the next generation

Jan. 27th 2015

Rethinking advice for parents

A recent article in The New York Times by Ron Lieber with the headline “Growing Up on Easy Street Has Its Own Dangers revealed the shocking news that many adult children of the moneyed class are not self-sufficient functioning adults. The article states:

 

There is an emerging consensus among academics that children of the affluent have higher rates of depression and anxiety and elevated levels of substance abuse and certain delinquent behaviors.

 

OMG! If this is news to you, what planet are you living on?

 

Ever since the ’60s, members of wealthy families have been self-reporting high rates of addiction, behavioral health disorders, abuse, and generalized dysfunctions in memoirs. Aside from personal stories, Joanie Bronfman’s 1987 dissertation, The Experience of Inherited Wealth: A Social-Psychological Perspective, documents what is common knowledge among the next-generation affluent: Yes, Houston, we have a problem!

 

But almost every wealthy family, when asked, will not admit to significant concerns about substance use disorders or underperforming, economically-dependent younger generations. Those of use on the inside – either because we are in recovery or in the helping professions – see a reality that is far different than the public façade. Not only are there high levels of substance dependence, but increasingly, financial conflict with parents and trustees stemming from the inability to independently sustain the lifestyle and social standing experienced as children.

Great expectations

As commented on in the New York Social Diary (your link to society), over the last 20 years there is the growing phenomenon of new wealth supplying their children with an endless supply of money to live the high life and impress their friends. While this assures those of us in the recovery business an endless supply of clients, old money’s younger generations feel enormous social pressure to compete and maintain prominence.

 

This group, having grown up in an environment of surplus, expects to live in a similar manner as adults and be supported by family money in doing so. Their parents often inherited in their 40s or even earlier. But now, with increasing longevity, the next generations are facing shortfalls and not happy about it. Lacking the skills or inclination to earn significant incomes in the job market, they are pressuring parents and trustees to pony up. While resorting to violence is obviously an extreme measure, cutting off access to grandchildren and threatening litigation with the attendant disclosure of family secrets is becoming more common.

 

Few take responsibility for slacking off in high school and college and consequently failing to develop marketable skills or spend within their means. Accepting a lower social profile or adopting a reduced standard of living is not an option. Resentments surface and demands increase, often fueled by excessive alcohol and prescription medication abuse.

Reaching a crisis level

We continue to identify substance abuse and behavioral disorders as the No. 1 risk to wealth preservation and next-generation well-being. While drinking and drugging have always been part of high-end culture, intensifying external social and media influences are leading to increased use and at younger ages. It’s beginning to reach a crisis level; parents are overwhelmed and outgunned, and we are not using our expertise to help them respond.

 

In my view, the primary task for family offices, advisors, and professionals is to support parents in setting limits, requiring accountability, and limiting communication tools, as well as being role models rather than peers. Advice on involving the younger group in philanthropy, family meetings, and business/economic exercises is secondary and can detract from the more important goals of learning life skills, developing academic and career interests, and differentiating from “the family.”

 

Let’s devote 2015 to assisting our clients in educating themselves on the risks to their children and responses that allow them to successfully navigate an increasingly hazardous culture.

The gift of a child – a heart-warming story for Thanksgiving

Nov. 24th 2014

Imagine you’re a freshman in college, still new in your sobriety. You walk into a Minneapolis coffee shop to meet a friend and encounter a struggling stranger who hands you her seven-month-old daughter to care for. You then return to your dorm with the infant where, with the help and support of family, friends, and dorm-mates, you become a mother.

 

It may sound like the plot of a sequel to Grand Canyon or Three Men and a Baby, but this exact thing happened 12 years ago to our long-time office manager, Jennifer, when she met and fell in love with her now-adopted daughter, Tiva.

 

The beautiful story of her journey as an adoptive mother was featured in the December 2014 issue of Parents Magazine in an article by Louisa Kamps. This four-page editorial takes the reader from Jennifer’s first happenstance encounter with Tiva, through the legal and financial struggles of being a young single mother and college student, and to their happy life now, which includes Jennifer’s husband Ron and their three-month-old son Mason.

 

“’In one sense, I knew it was crazy. But Tiva was so cute. And I think I knew intuitively that she was in need,’ Jennifer says. ‘I wasn’t analyzing then. There was a lot of adrenaline flowing. Day by day I didn’t know what was going to happen. Still my bonding with Tiva happened pretty quickly, even if I wanted to deny it to myself a little bit.’”

 

In treatment and early recovery, we are told unexpected good things often happen along the way. Jennifer and Tiva’s experience is truly a miraculous and wondrous event that was only made possible because of Jennifer’s commitment to her recovery.

 

This touching and honest story illustrates the power of love, family, community, and hope. All of us at Aureus are thrilled to see the Knutson-Winslow family recognized!

 

Click here to view a PDF of the article!

The family office and advisor guide to ayahuasca, rue seed, and shamans

Nov. 12th 2014

What the shaman is up with these people?

A recent article in the Times on ayahuasca highlighted a growing phenomenon on the use of this drug and a rue seed alternative sweeping the high-end community.

 

In a world increasingly dominated by screen time, not dream time, its not surprising that many people, having binged on yoga, are turning to a more dramatic catalyst for inner growth.

 

It’s said to be a spirit-enhancing, mind-altering, insightful experience leading to profound revelations and improved relationships.

 

It first came to our attention when a wealth advisor commented to us about a client who makes frequent trips to the rain forests and Peru. How often can someone visit Machu Picchu and travel the Amazon? And why is she so thin? Now it’s being alluded to at family meetings during sharing time as life-changing, with details provided in private conversations for the curious.

           

Talk of “journeying” and “shamans” – with offers to join in – are also pervading summer downtime at second homes and on the beach.

 

“Just try it once; it won’t hurt, we’ve done it many times; wait until you meet our shaman!”

 

Among upscalers, it’s hard to resist invitations from higher-caste friends to join in, given the dullness and intensity of corporate life and the opportunity to bond with the wealthy.

Lines in the sand

Right now lines in the sand are being drawn between family members who use or want to use the drugs and those appalled at the naiveté and self-serving justifications of the proponents. The former group usually has several heavily-invested participants who have journeyed multiple times, swear to its therapeutic benefits, and swear it is safe and non-addictive. In fact, advocates assert ayahuasca cures addiction (attested to by Lindsay Lohan, no less), as does the rue herb.

 

Dissenters are depicted as closed-minded and rigid for suggesting that users are simply drug-seeking under the guise of a spiritual or therapeutic experience. Those in recovery are dismissed as overbearing scolds and misguided for questioning the legitimacy of the claims and objecting to participation by next-generation family members. And it’s becoming increasingly difficult to counteract the momentum of the one-two punch sales pitch of the devotees and purveyors of these drugs.

What is really going on? What is the attraction?

Using drugs to gain insight into personal or relationship concerns and enhance spirituality has a great deal of appeal, particularly after years of failed therapy. Many inheritors have been on a life-long search for ways to overcome chronic dysthymia, attachment disorders and anxieties stemming from poor parenting and an inability to connect with others. With a full understanding of the risks, experimenting may lead to insight for some people. However, after doing so once or twice continued use can easily transition into drug seeking – using for the sake of using. As psychologist Terry Hunt says, “Once you get the message, hang up the phone!”

 

But that’s not happening.

All the perks without the stigma

Now at later stages in life, a “spiritual person” comes along offering a supposedly safe, therapeutic herb that provides a heavy-duty escape from reality – the first time they feel like real people. It’s an experience they want to repeat over and over again, and share with others. For many who experimented with hard drugs (or wanted to) in their younger days but are stuck settling for a few cocktails, glasses of wine or Xanax, journeying is the high they are seeking without the stigma of LSD, PCP, or MDMA. They consider themselves on a spiritual journey, the perfect antidote to the ennui of the affluent lifestyle. And what’s the going price? As much as $2,500 per day for a house call – drugs (whoops, herbs) included.

‘Have I told you lately that you’re crazy?’

Inspired by an article in a NYT Sunday Review with the same heading: “Have I told you lately that you’re crazy?”, it’s time to present an alternative view, examining the very real risks and potential damage from using these drugs.

 

“It’s safe!” (Not!)

 

Ayahuasca is said to be a psychedelic affecting dopamine receptors in particular and can penetrate deep within the brain. It causes many users to vomit, which is why a rue seed herb is offered as an alternative, particularly to newcomers. The latter is a stimulant, acting on the limbic system (the reactive, fight-or-flight, primitive area of the brain) and depressing the executive control area of the brain. It also causes altered visual perception and gait. Alcohol is given to help bring users down off the high. Both last for six hours or more and require oversight by a “minder” – often the shaman – to make sure the user does not wander off or trip out.

 

We are talking about heavy-duty drugs. Like LSD, ayahuasca has the potential to create flashbacks. The larger problem is that stimulating the limbic system while deregulating the executive frontal lobe can lead to impulsive decisions and destructive communications. There are also reports of disorganized thought process from multiuse. But hey, what’s more important than expressing feelings and acting on gut instinct? For vulnerable people, taking these drugs even one or two times can lead to a marked personality change (e.g., blowing up a Type-A personality).

 

Take them 10, 20, 50 times and it’s a recipe for permanent brain alteration, even for the most resilient.

 

It’s a tea or herb concoction.”

 

These drugs are described in medicinal or culinary terms – tea and herbs – to overcome the stigma associated with hard drugs. However, when any mind-altering drugs are ingested, the body converts them into molecules that pass through the brain barrier and react with brain cells.

  • The brain does not distinguish between ayahuasca or rue seed and meth, cocaine, PCP or LSD – the reaction is similar. Nor does it care whether you got them from a dealer, an ostensible healer, or the Pope.

Both drugs have major impacts on the body and mind – that’s why the shaman babysits users.

 

No, ayahuasca and rue seed are potent drugs, regardless of how they are described.

 

“It’s a permitted spiritual practice, exempt from drug laws.”

 

That’s the line for first-time initiates who may be concerned about getting into trouble with the law. Passing use off as spiritual – and therefore legal – is bogus unless the participant is a member of a recognized religious group authorized to use ayahuasca in ceremony. Promoters tend to skip over the fact ayahuasca is a controlled substances and is therefore an illicit drug. (One reason why users go to South America.) The rue seed alternative in its various forms, flies under the DEA radar for now, although a very potent drug.

 

“It’s non-addictive.”

 

The real measure of addiction is whether drugs impact brain cells in the pleasure center (dopamine, serotonin receptors) limbic system and frontal lobe. As discussed earlier, since the reactions when taken are similar to other drugs that alter the brain, the conclusion is that ayahuasca and rue seed do indeed modify cell structure, unless proven otherwise. Take them enough times and there will be significant and permanent alterations. By the way, anticipating the next journey, common among many repeat users, is indicative of addiction.

 

It acts like other mood-altering addictive drugs, so why take the risk?

 

“It’s therapy.”

 

Prospective participants are told shamans are therapists. Some even come with university degrees (but no credible credentials or license certifications). It’s a two-for-one deal. But wait! What kind of therapist prescribes the same treatment to every patient after a five-minute conversation and then drops fame-names of clients as a selling point.

 

That’s not a healer, that’s more like a sales pitch.

 

Don’t ask, don’t tell approach to medical issues

 

A lot of these insight-seekers are not young people. (Many would be eligible for social security if they had ever worked.) Some have heart problems (e.g., a-fib, weak valves, high blood pressure, etc.). But why take a medical history, that’s so allopathic! Just crank that old beater up to 120-130 BPM for a few hours. And then “journeyers” wonder why their meds don’t work or they are at the Mayo clinic for major surgery. (Note to advocates: This is another criterion for addiction – taking a drug that you know could give you a coronary or a-fib problems and doing so anyway.)

 

Inexcusable in so many ways.

 

“It cures addiction.”

 

The first question to ask anyone touting this cure is “Show me your supervised drug screens!” because addicts are notorious liars. Both ayahuasca and rue seed act on the very areas of the brain affected by use of alcohol and other drugs. Actually, rue seed triggers intense cravings for anyone in remission from a substance use disorder. So no, it does not cure addiction and is just another form of addicts tripping out on a mind-altering substance.

 

This is the most bogus of all claims: giving someone addicted to controlled substances another psychoactive substance to cure addiction.

 

“It cures depression.”

 

How about encouraging participants to stop taking their antidepressants because their un-medicated self is just fine? Then they wonder why family members stop visiting and friends are so busy. You can be sure participants did not discuss this “cure” with their psychiatrists or other prescribers.

 

No, you are not fine!

 

Multigenerational use

 

Apparently, parents are advocating multigenerational use to become closer to their children. Whoa. What a way to avoid the hard conversations about the multiple marriages and being too self-absorbed for effective parenting. Get high together and all is forgiven.

  • And who doesn’t want to take parent-approved heavy drugs? Come on down!

Talk about playing with fire! Many adult children are in families with histories of alcoholism and drug dependence. Prolonged and intense use of any drug can trigger the addictive gene, despite apparent parental immunity.

 

Does it get much crazier?

Alternatives to seeking meaning and improved relationships through drug use

Participants are reported to say things like “I was never able to talk to my sister about our differences until we went on a journey together for six hours.” Well, did you ever try? Spend six hours with any competent therapist (yes, they do exist) and you will likely explore in depth any ill feelings between relatives or friends – and actually remember the conversation and what happened during the session. Moreover, drug-induced insight does not necessarily lead to behavioral change (e.g., more time with and an improved relationship with the sister).

Do no harm

It seems every few years, a new mind-altering phenomena spreads like wildfire through trust-funders and the newly-minted affluent. Remember Swami Rama, the Rajneeshee, Ram Dass, cults, EST? The list goes on and on. These guides to enlightenment are completely unregulated and hold no licenses yet are purporting to fix major trauma and behavioral health issues. The first rule of any healer is to do no harm. From observation and reports, the harm done to some participants far outweighs any asserted benefits: destroyed relationships, distorted thinking, drug cravings, and untreated depression. Keep at it and we are likely to see drug-induced psychosis.

 

Unfortunately, the wealth and prestige of many of these journeyers keeps them insulated from contrary opinions and negative feedback on personality changes or distorted thinking. Like any good addict with unlimited resources, they have little incentive to stop. Contradictory information isn’t going to change their minds, but it should give pause to anyone thinking about joining the club. Perhaps by alerting family offices and advisors to this very underground and growing phenomenon, proselytizing can be minimized and support provided for the contrarians who are telling their friends and relatives, “YOU’RE CRAZY!”

NYT recognizes John A’s vision for estate planning

Nov. 10th 2014

This past weekend, I was thrilled to see John A. Warnick featured in The New York Times for his accomplishments in creating the Purposeful Planning Institute. In the article, “Focusing on the Human Element of Estate Planning,” John A receives well-deserved recognition for taking the initiative (and risk) to focus estate planning on transmitting family values rather than merely asset preservation.

 

“What we stand for is making sure the planning has a deeper purpose and meaning to it than just being driven by taxes,” Mr. Warnick said. “The challenge is to get those core planning disciplines — lawyers, C.P.A.s, wealth managers — to start with ‘why’ instead of immediately marching into ‘how.’ ”

 

John A began thinking about how traditional estate planning was missing a key element – the impact on beneficiaries – after receiving an irate call from a 21-year-old complaining about a delayed distribution.

 

But this particular call got Mr. Warnick, then a lawyer at a large law firm in Denver, thinking about how estate planning was missing the human component. The emphasis was on transferring the most money to heirs free of estate tax and then insulating that money from creditors. “I said, ‘There has to be a better way to do planning so all this tax-efficient, elegant trust planning doesn’t hurt people,’ ” he said. “I saw well-intentioned, technically precise plans reap negative unintended consequences.”

 

In my experience working with families and trustees dealing with addicted and/or dysfunctional beneficiaries, far too many trust documents lack effective provisions to prevent the “negative unintended consequences” he is talking about. So, again, congratulations to John A helping parents write estate plans that help rather than hurt their heirs.

Granny’s on pills, Pops is a drunk, our kid’s back home, and we’re sunk…

Nov. 3rd 2014

Singing the Sandwich Generation blues

With parents living longer, it’s no secret that many are overdoing it with alcohol and popping mind-altering substances at an alarming rate. A recent article in the Times, “More Older Adults Struggle with Substance Abuse,” highlights a growing problem for many adult children trying to figure out what to do with a sometimes-dysfunctional parent or relative. These using seniors certainly don’t want to be told they need help, but you can hardly sit idly by when you’re the one left to deal with the negative consequences – both on the family and on finances.

 

The Times article talks about seniors going to treatment and what a wonderful life they have in recovery. Big deal! What wishful thinking! Our parents may need help, but they’re not going to get sober just because we think it’s a good idea. Let’s look at a few common scenarios:

Dad

He has a few drinks, becomes obnoxious, and staggers around.  His children don’t want their kids near him. None of the kids wants to confront Dad because he is old and deserves some pleasure in life (read: If confronted, he is very likely to cut them out of the will). But when Mom privately confides Dad becomes physically abusive at times, doing nothing becomes less of an option.

Mom

She’s becoming more confused and forgetful. Is it dementia? Or has she been riding down at the WA ranch, combining wine with Ambien? She did mention going to her doctor to discuss what to do about waking up at night…

Auntie

The family recluse, she has acute cellulitis but refuses hospitalization because she won’t be permitted Valium on demand. When her trustees are contacted to exert pressure to go to the hospital, they become flustered and defensive, saying they don’t judge a beneficiary’s lifestyle.

Younger Brother

He’s overweight, out of work, and gains sympathy (and subsidies) from Mom because he’s diabetic. While his preference is for a six-pack a day, due to a recent fall, he’s on pain medication and showed up in stupor at a recent wedding.

Older Sister

She’s been smoking weed for forty years – one reason she can’t string two thoughts together. After privately touting it to the next generation as superior to alcohol, she’s now soliciting family members to join with her in “journeying” on herbs with her shaman.

Stepmom

Dad’s third wife is close to your age and has been overheard – after several drinks –  muttering, “I never thought the SOB would live this long.” She’s way too far into wine at fundraisers and a danger to the public when driving home. Your formerly-robust father is fast becoming elderly and more dependent on this women.

You

You are the responsible one – the one who either feels obligated to assist your relatives or was told by Mom and Dad to do so, particularly as they aged.

 

If none of these scenarios is familiar, you are the lucky one. For many of us, these are constant worries that show no signs of disappearing. But what to do?

Finding leverage points

As mentioned, people with problems (PWP) don’t seek help simply because they are asked to. If they do, it’s usually only to placate and create the appearance of taking action, when they have no intention of changing.

  • But with doctors handing out pills for minor pains and inconveniences; marijuana becoming the preferred drug for teens*; and alcohol embedded in our culture, legalized impairment is fast becoming the family norm.

It can seem an insurmountable task to eradicate substance use and addiction altogether, but it doesn’t have to be an all-or-nothing approach. Sometimes, the best thing we can do is help our PWP, especially seniors, manage the process to keep everyone safe and minimize damage.

 

As our readers know, we advocate utilizing planning documents with language aimed at encouraging PWPs to alter their behavior. Without advance planning (see below), we use medical concerns, video feedback, environmental interventions, and incidents as opportunities to motivate change. The idea is to identify or create leverage to encourage the PWP to see a doctor, therapist, or even enter an inpatient setting for evaluation or treatment.

Indirect methods

Rather than tackling the concern over alcohol or drug use head on, indirect methods can be successful as a means of accomplishing your ultimate goal. By indirect method, we mean using an event or activity seemingly unrelated or indirectly related to substance use to initiate the change process. While these are not proven recipes for success, they’ve worked on some occasions.

 

MEDICAL OPPORTUNITIES

 

These include attending annual checkups, memory-loss exams, brain scans, hospitalization for conditions unrelated to using, and accessing health care records and information.

 

Routinely attend medical and other health appointments with the PWP

 

These are a great source of information, particularly if the PWP signs a release so you are privy to medical records and can speak with providers. This is good practice regardless of the medical condition. By monitoring prescriptions, you are already in the loop if pill abuse becomes a problem.

 

Hospitalization or day surgery for unrelated conditions

 

Seniors with drinking or drug problems sometimes confuse the hospital with the Hotel California and are unhappy to find cocktails banned and pill use regulated. The hospital is very likely to put your PWP on a detox protocol to prevent serious withdrawal symptoms. Ask for this protocol because many people don’t stay in the hospital long enough to complete withdrawal.

 

Brain scans for falls, spills, and memory issues

 

The scan can be initiated at the suggestion of a physician when the PWP has a fainting spell or other symptoms that might be “brain-related.” A scan may show deterioration due to alcohol or drug use.

 

Exploring behavioral side issues (e.g., depression, ADHD, gambling, Internet)

 

Encourage your PWP to seek help for a mental health problem and then raise the topic of addiction with the therapist at an opportune time (“Oh I see this antidepressant medication does not work if you drink regularly. What can be done about that?”)

 

Professional evaluation/in-patient evaluation

 

If your loved one expresses concern about health or behavior and may be open to an evaluation at a place like the Mayo Clinic, encourage her/him to do so. Be sure a medical release is signed so you can express your concerns to the staff. Or, if the PWP is willing to be evaluated by an addiction program, have the name of one or two quality programs to recommend, as well as several addiction specialists.

 

ENVIRONMENTAL STRATEGIES

 

These proactive suggestions can be very effective, although some may find them too invasive or Machiavellian. But when other relatives or vulnerable adults are at risk, you may be compelled to take action.

 

Videotape feedback

 

Many PWP are unaware of how they present themselves or simply don’t remember negative incidents. Video footage from family gatherings and celebrations is very useful for blackouts and for convincing relatives there really is a problem.

 

Video evidence can be helpful if a PWP has control of assets and a conservator or guardian proceeding is contemplated. This technique is also used by family-employed security personnel to record interactions with drug dealers or if the PWP drives under the influence.

 

Granny cams

 

Video cameras installed in parents’ homes are used for documenting behavior, as well as making sure all is well. While painful to see, suspected abusive behavior by out-of-control Dad and the Third Wife will be corroborated.

 

Obtaining permission to install cameras can be a problem. Using security concerns as a pretext is often effective. Of course, it is important that you control access to the recordings. To do so, you should pay for the installation and ongoing costs.

 

Helpers in the home

 

Having an ally involved in the PWP’s daily life can be very useful. Depending on the financial situation and relationships, you can pay the helper directly or assure the helper that s/he will be paid even if the PWP finds out the helper speaks with you.

 

Family hire staff and fire enablers

 

When there is concern about regular use to the point of intoxication, passing out, and danger to self or others, you can hire staff to protect that addict from self-destructive behavior, encourage the addict to use less, and perhaps enter treatment. This can be done with both new and existing staff. Staff that is helping the addict access alcohol and drugs must be either re-educated or terminated.

 

PUBLIC INCIDENTS

 

Using-related embarrassments at weddings, country clubs, cocktail parties, etc., can be used as leverage. However, the addict usually has an excuse for what happened.

 

“I tripped on the stairs.”

“I ran into an old buddy from college and drank more than I should have.”

“I accidentally drank wine after taking my Xanax, and it’s the medication.”

 

Keep your eye on the behavior, not the rationale. Do not accept it. Addicts like to argue intent and happenstance. These become even more effective leverage point if the family member has a job where reputation is important, particularly if there are fiduciary responsibilities.

 

FAMILY PRESSURE

 

When everyone in the family is on the same page and working together, they can be effective in encouraging change.

 

Family educational and informational activities

 

Education on addiction ranges from individual sessions to seminars to weekend workshops. The PWP may or may not be invited to attend. Genograms with information about previous generations are opportunities to engage the PWP in discussions about genetic predisposition. For affluent families, discussing addiction in the context of risk to wealth preservation can also resonate.

 

Limiting visits

 

Limiting time with or avoiding a PWP grandparent can be effective so long as the other grandparent is on your side. Even with a sympathetic grandparent, the hard question is: Do you tell your dad or mom the reason for your actions, or do you simply remain silent?

 

TALK ABOUT IT

 

The “talk about it” approach, at a minimum, benefits responsible adults and children because it explains behavior and relieves the burden of secrecy. It also changes the dynamics of the family system, which may inspire the PWP to consider seeking help.

 

Name the behavior

 

Most immediate family members don’t talk about their PWP with relatives, close friends, or even their children out of concern for privacy or shame. But when we cover up the problem, we become part of the problem. And our children – who know there is something wrong – mistrust us, and even more importantly, misunderstand the power and danger from alcohol use. This is exactly what happened to me with my grandparents.

 

So Brother at the wedding is not “tired from working too hard” but a long-term substance abuser. Auntie is more than simply sick, having been victimized by her psychiatrists who prescribed her benzos for years. These are cautionary tales for our children, and once we start talking about our concerns with the larger family, support staff, and friends, a lot of the shame and stress goes away.

 

Be forthright and frank

 

Many of us fear offending others, but it’s OK to say: “No, I don’t want you talking to my children or other relatives about weed or journeying.” Or, “No, it’s not OK to come to meetings high. We are no longer putting up with this craziness.”

 

PLAN AHEAD

 

By participating and overseeing the estate planning process for your parents, the goal is to create sophisticated, anticipatory documents that allow for shifting of power, control, and access to medical and financial information to you or trustees.

 

Anticipate the problem with documents

 

Make sure effective documents are in place so that when the PWP gets out of hand, the documents provide a means to take control of assets and loving situations.

  • For siblings or next-gens, this usually means having Mom and Dad insert provisions into succession planning documents (e.g., trusts, business, inherited property, and charitable entities) that effectively address behavioral disorders.
  • For parents, this means putting provisions into documents when they are younger and committed to their estate and health plans that will ensure their intent is carried out. Use trust protectors, co-trustees, and other safeguards so modification is difficult, if not impossible, when issues arise later in life.

Similarly, health care directives and powers of attorney for decision-making and control of assets outside living trusts are useful when parents deteriorate or when using behaviors begin to escalate.

 

Living situation

 

No seniors want to be told they may no longer drive or live alone in their home. It’s easier to make the transition if plans are made well in advance to move to a community designed for independent elders, with additional support services available. Then, it’s time to put the plan in place when concerns about driving or even drinking too much come into play.

Don’t turn a blind eye

The disease of addiction will eat away at the body of the family as swiftly as any cancer. Turning a blind eye to substance use by seniors in our family is, at best, unproductive, and at worst, dangerous or even deadly. It isn’t as easy as wishing for change and having it be so, but adopting some of the ideas or plans in this article can help put recovery – or at least an improvement in behavior and family dynamic – in motion.

*For information about young-adult using and “failure to launch,” see these related blogs:

Teenage popularity: blessing or curse? Why affluent adolescents fail to launch

Young-adult addiction: College students hit the bottle, the bong, and sometimes the books

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.

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.”