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:
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.
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…
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.
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.
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.
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 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.
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.
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.
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.
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.
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.
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.
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 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.”
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.
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: