Category Archives: Parents

Pills, pot, and legalized impairment

Cautions for parents, family offices, and wealth advisors

At recent conferences in Colorado and California, several colleagues asked for my thoughts on legalizing marijuana and how it might impact families and the workplace. It’s all over the news and one everyone’s mind, but frankly, it’s not just pot that’s a concern – there’s a whole range of substances family offices and advisors should be aware of.

 

So it’s time to introduce a new concept into our lexicon: legalized impairment. This term refers to society-sanctioned drugs that significantly alter mood, behavior, and judgment. As they become more widespread and readily available, more and more people are using these drugs to excess. This group includes underage users, who, as we know, have easy access to all kinds of substances.

 

Due to their legal or quasi-legal status (often doctor-prescribed), these substances pose a significant risk to family office integrity. As a family office executive or wealth advisor, the last thing you want do is explain odd, unprofessional, or improper behavior by a colleague or employee to clients. While you may want to address the concern in family members, increased drug use is growing and impeding efficient professional-client interactions.

 

So, what drugs are we talking about?

 

Pain killers, benzodiazepines, ADHD meds, sleeping pills, e-cigs, weed, salts/herbs, and alcohol.

 

It’s quite the list and growing weekly. No doubt these drugs have already invaded your office and befriended your clients. As an advisor said to a friend of mine in recovery, “You mean when you wake up in the morning this is the best you will feel all day?” This question reflects the reality that in our culture, we routinely use drugs to feel better. And now we have more and more-potent options that bring with them greater risk of abuse and dependency.

 

Let’s look at these drugs in greater detail:

Pain killers: oxycodone, Percocet, hydrocodone

Over-prescribed in large quantities for relatively minor injuries or procedures, they are easy to get hooked on and hard to quit. When doctors do restrict refills, pills are available from dealers but are often more expensive or harder to obtain than heroin. Substituting more readily-available heroin for pills is a main reason why apparently well-off and functioning people die of opioid overdoses. (Dealers offer free samples, so why not give it a try?) Pain pills are also highly sought after by students to come down from Adderall and Ritalin and other stimulant-induced study or test-taking highs.

Benzos: Xanax, Klonopin, Valium, Librium, Ativan

Commonly prescribed for anxiety, these drugs are known as “alcohol in a pill.” Contrary to the opinions of some doctors, they do lead to increased tolerance and dependency. They’re also known for their boomerang effect: Over time, they produce the same symptoms they are designed to alleviate. Supposedly prescribed for the short-term, many are in it for the long haul, with mind-boggling withdrawal symptoms when users run out or try to ease off.

ADHD medications: Adderall, Ritalin, Vyvanse

Known as study drugs, parents seek them out for their children to give them an advantage on tests. Whether used for legitimate ADHD or just for a leg up on the competition, these drugs open the door to illegal stimulants such as cocaine, ecstasy, or meth. Coming down from the high can be a problem, and kids resort to fighting the high with depressants. Common “antidotes” include pain medication, weed, or alcohol.

Sleeping pills: Ambien, Lunesta

Touted as risk-free, when taken regularly these drugs cause restlessness, anxiety, memory loss, and occasionally bizarre nighttime behavior. When taken with alcohol in the blood stream, it can be difficult to wake up in the morning.

E-cigarettes: nicotine

E-cigs contain varying doses of nicotine – a highly addictive stimulant. They’re a go-to for people who’ve overdone it the night before and need to shake the cobwebs off in the morning. Other users believe nicotine helps them concentrate, so it can serve as an alternative to Adderall and other stimulants.

Marijuana

The younger generation believes it’s benign. The older generation is getting back into it (or never quit) – for medicinal purposes, of course. So what do we know about it? Marijuana can interfere with memory, perception of time, and motor function. Repeated use during adolescence can result in long-term changes to brain function. Available in increasingly higher percentages of THC (the active ingredient), drug-induced psychosis is becoming more prevalent.

Salts and herbs

Claimed to be unregulated and largely flying under the DEA’s radar, they are often as potent and destructive as the other drugs discussed here and can be highly hallucinogenic. Available online, from head shops, and from your friendly shaman, these substances run the gamut from bath salts to rue plant derivatives and ayahuasca.

Alcohol

Alcohol is easily the most prevalent of the legalized impairment substances. As the accepted social lubricant among the affluent, you’d be hard pressed to find a work, family, or social gathering that doesn’t serve cocktails before, during, and after the event at hand.

 

It’s no secret that excessive drinking is considered a major public health problem, but most of us in the affluent community would scoff at the medical definition:

  • For men, it’s five or more drinks in one sitting or 15+ in a week.
  • For women, four drinks in one sitting or eight in a week.

In our culture, these suggested limits are exceeded regularly and with little awareness that tolerance is increasing. We ultimately can become dependent, particularly as we age. After age 40 or so, alcohol takes longer to leave our system, meaning drinking the same amount will have greater effect.

What to do?

I encourage drug testing because it is the only way to truly determine actual substance use. It also has a preventive effect because people are less likely to use when they know they will be tested regularly.

 

For the family office:

 

Because of fiduciary responsibilities and client relationships, it’s important to regularly drug test all employees. There’s nothing more maddening than trying to figure out why an employee is acting strangely and mishandling client interactions. I also recommend establishing a policy for persons using prescription narcotic medications – and include marijuana as well. Of course, these procedures will need to be vetted and approved by a lawyer who is familiar with state and federal employment and disability laws.

 

I’d also recommend an educational program for staff on different types of narcotic prescription drugs, dosages, and their effects and side effects. This will help with self-awareness and also with client relations because many clients discuss medical conditions with their account representatives.

 

For clients:

 

Encourage your families to establish effective provisions in their policies and governing documents to address substance and behavioral health disorders (see my article, “Model Language for Addressing Substance Use Disorders [Addiction] in Trust Documents: Best Practices for Treating Substance and Other Behavioral Disorders). Educational programs are also helpful, as are discussions among the younger generation about what they would like to see happen if someone is abusing alcohol or drugs. Taking a strong stand on alcohol and drug use can set the tone for the family, especially if it is backed up by moderate, responsible drinking at family events.

 

For families with a history of addiction or mental health issues, a joint project such as a family genogram can help trace these disorders through the generations to the present (see: www.2164.com). It really helps illustrate the concept of “genetic load,” meaning that when the gene linked to addiction is present, there is good chance that the next generations will be susceptible to the disease.

 

This may sound very controlling and Machiavellian, but drug testing young adults as a condition of receiving funding might also be appropriate, given the widespread substance use in this group. Family members don’t like to see a relative destitute, so there might be two levels of payment for compliance and non-compliance (e.g., minimum subsistence for positive test and the regular payment for passing the test).

Address legalized impairment head on it will steamroll you!

Addiction is already the primary threat to family stability and well-being. With more heavy-duty drugs legalized, legitimatized, and available, this risk is only going to increase. Your choice, as an advisor, leader, or family member is to attack this issue head-on, or it could very likely become the predominant driving force in your clients or your own family system.

 

Due to popular demand, a future blog will explore in detail the topic of marijuana. Before doing so, I wanted to place weed in the overall context of legalized impairment.

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

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

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

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…

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

Wealthy, famous, powerful, and addicted – Part VII

Barriers to recovery: suppressed pain

Suppressed pain: submerging the intolerable and denying our experiences

“Hey, it’s not so bad.”

 

When we ask ourselves, “Why am I killing myself with alcohol and drugs?”, it’s a question many are unable or unwilling to explore: The answers are either buried deep or too intolerable to address. When coupled with addiction, our pain only intensifies, with suppressed pain being the primary reason affluent people who actually want to recover relapse repeatedly.

 

Growing up in families of wealth, power, or prominence, the outside world perceives us as fortunate, equating good fortune with an easy and contented life, far superior to the other 99%. We were raised to believe happiness meant avoiding pain. With money and means, we can limit suffering, keep up appearances, and avoid embarrassing situations. The art of living then becomes the art of learning to suppress and deny negative experiences. When coupled with addiction-based denial, it becomes a double-edged sword too painful to touch.

Undermining our assumptions

Years ago, I joined a support group for adults from wealthy families. Many of us were suffering and uncomfortable, but we couldn’t identify why. Only when candidly speaking with one another did we discover common childhood experiences that undermined our assumption that being born into affluence guaranteed happiness and satisfaction. Later in life when I went to treatment, these insights helped me dig deeper and examine what was driving my addiction – an essential task to achieve sobriety.

 

Addictive behaviors inevitably are rooted in suppression or avoidance of pain. Even when we do recognize things aren’t right, it’s so much is easier to gloss them over with a drink or drug than do anything to resolve them. Unfortunately, the treatment community offers little in the way of expertise or rapport in supporting us as we pursue feelings relating to difficult childhoods and – too often – trauma. Because understanding and exploring suppressed pain is so critical to our recovery, this blog will discuss its meaning and manifestation, saving its impact on treatment and recovery for next time.

 

What does suppressed pain mean?

 

Events and experiences that hurt us and are submerged into our subconscious, denied, or reinterpreted.

 

Repressed pain comes from experiences that are too intolerable to hold in our consciousness. Examples:

  • Absent, perfectionistic, and critical parenting.
  • The child as the parent’s primary emotional relationship (i.e., becoming the love or hate object of a parent).
  • Abuse.

Denied pain comes from events we reinterpret so as to change their meaning. Examples:

  • “We had it so much better than others, we don’t deserve to complain.”
  • “When the going gets tough, we keep a stiff upper lip.”
  • “They invited me to dinner because they like my company, even if they do want a donation.”
  • Not speaking up when negative comments are made about the wealthy to be “nice,” when we’re actually afraid of confrontation or feel we “deserve it.”

We’re constantly told how wonderful and important our family is that it’s hard to fathom we might suffer from neglectful and misdirected parenting. By denying or suppressing painful experiences, we internalize negative messages about ourselves or our families.

Our childhood reality

Negative messages about us or our families

  • Children hear these messages more often than parents because saying them to us is safer than directly attacking the source of the resentment.

Parental pressure to be perfect

  • The object of parenting is to turn out the perfect child, with no infraction too minor to overlook.
  • We are expected to follow in the footsteps of previous generations.
  • An overly-critical environment leads to an internalized sense of never being good enough.

The molded child

  • If we accept the role of the molded child, all aspects of our life are directed by others. (Often money is the carrot.)
  • We fear leaving this protected environment. We have no idea of who are apart from our parents and little insight into our lost self.

Parents relate to us on their terms and ignore our wishes

  • We learn to deny our own feelings. “What I feel doesn’t matter.”
  • This leads to low self-worth, particularly when we see our parents being attentive to others, like servants or social friends, or spending time on philanthropic events. “Why don’t our parents have time for us?”

Parents absent, raised by servants

  • We feel abandoned. This leads to detachment and inability to connect with others. “A sense of observing ourselves participating in life, rather than feeling present.”

Turnover of (hired) primary care giver

  • This inconsistency leads to lack of trust and feelings of powerlessness, resulting in both abandonment and furthering the detachment generated by parental absence.
  • Our closest relationship is often with our nanny, not our mother. “The only time my heart was broken was when my Nana left.”

Parents confuse being present in the home with having a relationship with children

  • We experience a lot of isolation and insecure feelings, even around siblings or the extended family (i.e., anxiety, a sense of unease, “an acute sense of loneliness”).

The awareness of us versus them

  • We notice the real differences between us and others, in contrast to the egalitarian principles learned at school and religious institutions.
  • We observe, but do not understand why. Many of us adopt the belief we truly are superior in order to reconcile the reality of differences. Others try desperately to fit in.
  • In either case, the feeling of separateness is in the driver’s seat.

Above all, we grow up learning that it almost impossible to act on our own beliefs, if our beliefs differ from our parents’, because of internalized messages and a “system” designed to foster dependence, not independence.

Our adult reality

As we mature, we realize our lives aren’t any better than others. In fact, they’re worse in many ways because we are different from our friends; our parents aren’t around; and we’re pressured and expected to excel. As we think back on our childhood, we become increasingly aware as to how our upbringing impacts our lives and behaviors as adults:

 

Longing for a normal life

We often long for “normalcy,” but don’t know healthy ways to achieve it or quell the underlying feeling that something is wrong. Because we don’t know our own needs, it is easy to be misled, duped, exploited, and a “people pleaser.”

 

Problems? What problems?

We may actually want to stop or cut back, but without our reliable “friend” to keep our uncomfortable thoughts and feelings from surfacing, we continue on until we believe we can’t live without using. Life becomes intolerable without alcohol and drugs, but unresolved pain drives our addiction and our relapses.

 

Living in a cocoon

By minimizing our experiences and telling ourselves it was “not that bad,” we deny reality. And by deliberately ignoring or suppressing our reality, we lose the ability to learn information about our lives, including our drinking or use. Our feedback mechanism is defective, and people who are honest with us are replaced or ignored.

 

Money and resources to the rescue

Shopping, spending, sex, and other peak- or adrenaline-driven activities can be just as useful to avoid pain. All are interchangeable, and when drugs and alcohol become a problem, do we realize how pervasive pain avoidance has become? When the going gets tough, we spend money. And why not? Without understanding the connection between money and addiction, recovery is a fantasy.

Who can help us?

In moments of clarity, we have all these feelings we want to try to identify and talk about. But with whom? Who understands us or can help us gain insight and perspective? Who will be respectful of our experiences and not exploit us?

 

Here’s the bottom line: Without insight, we tend to reenact the struggles of our parents, even though we often vow not to – leading to our own dysfunctional lives. The same rejection and abandonment issues that create the drive for fame and wealth in the family founder can replay themselves in their offspring – leading to their need to be significant in their own right.

Pain as a source of information

We are taught from day one to learn to treat pain as a negative, rather than a source of information. A healthy attitude toward pain recognizes that pain is the soul crying out for help or the body crying out for attention. If we didn’t have physical pain, we wouldn’t know when our bodies are in grave danger.

 

Certainly, having discomfort gets our attention, so it’s not necessarily a bad thing. But for us addicts, alcohol and drugs are the reliable friend who is always there for us. And we prefer our “friend” over connection to aliveness. The consequence of our double denial is living an unconscious life, not understanding what life is about, not taking care of ourselves, and not listening to the data from our own life.

 

This all may seem bleak, but it’s our reality – a reality that we can change by understanding how suppressed pain impacts recovery and how a healthy attitude toward pain treats it as an opportunity to improve our lives. Don’t stress out too much; help is on the way in Part II.

Wealthy, famous, powerful, and addicted – Part VI

Barriers to recovery: the Myth of the American Dream

Myth of the American Dream: With money and success, all our dreams will come true.

“While we spend our time enjoying the American Dream, in reality, is it all a lie?”

 

For the well off, America – The Land of Dreams, becomes America – The Land of All Your Dreams Come True. We’re raised to believe that having money means being happy and successful. For those working hard to accumulate wealth, we know one day our life will be one of leisure and worry free, as we delight in our deserved riches.

Wealth creates its own set of problems

“I have all this money, everyone tells me I should be happy, but I’m not and my using is out of control. What happened to me?”

 

The reality is that having wealth, earning high incomes, or accumulating money creates its own set of problems. Those who aspire to “make it” fail to understand the (mostly) hidden, pervasive dysfunction permeating affluent families and the ensuing guilt over leaving friends behind. Wealth, beauty, fame, and power are called the four curses due to their negative impact on the lives of their owners. Yet most people aspire to or would like to have any one of the four curses, believing their life would be better off no matter what the trade offs are.

Another hurdle to overcome

Being an alcoholic certainly is not fulfilling the American Dream, and when struggling with addiction, the Myth can be another hurdle to overcome. When addicted, we are living proof that the American Dream is fantasy, but the Myth soothes us and allows us to believe that we are living the good life and there can’t be any problems, so we continue on.

 

The Myth influences our lives in many ways:

  • We believe the Myth. Everyone tells us we have it so good – so we believe our experiences and feelings must be wrong. We don’t acknowledge the problems in our lives because we buy into the idea that our lives must be wonderful. This leaves us open to exploitation and an inability to take action to protect our selves because we can’t see our vulnerabilities – we are bullet proof.
  • People around us believe the Myth. We can be treated as objects to be seduced, deceived, or conquered by those who want a piece of the dream. Even our peers and counselors believe our lives are fantastic and refuse to accept that we might have problems.
  • We idealize the “family founder.” We adopt family stories about the famous family founder – without also examining the negative traits or luck that led to his/her success. We can never live up to the achievements of our family or fulfill our obligations to the world, when our forbearers become our idols.
  • We think achievements will make us happy. Especially for the self-made, we assume reaching our goals would make us happy – instead they often leave us miserable and searching for meaning.
  • We live our public image. We comply with the ought-tos and shoulds imposed by the life stylized for us by the media, merchandizers and our internalized messages. Whether ski goddess, corporate gladiator, trust funder, rock star, or philanthropic do-gooder – we spend our time acting the part and rarely experience who we really are.

Few experiences are more compelling than speaking with:

  • A lottery winner who is in treatment and can’t figure out what happened or why the newly-adopted lifestyle might be part of his problem: “You mean I should stay away from the Cubs, Blackhawks, Bears, Bulls, and the casino when I get home! What will my friends do without me?”
  • The tech guy who cashed out, with the much-envied wine cellar basement and accompanying bottle habit that makes him an unreliable parent and absent spouse.
  • The 40-year-old beneficiary who is filled with self-hatred when working at a recovery job at Home Depot.

These scenarios call for compassion, not scorn, because we, like them, all buy into the Myth at some level.

The Myth as an external message

While there are many similarities to other barriers, a difference is that the Myth is much more of a cultural, social, and media-driven concept, reinforced multiple times each day. In one sense, this is the other side of the coin from envy and resentment, which offends us, in that the Myth is something we become committed to. It makes acknowledging our addictions and seeking help to recover more challenging because we believe we cannot possibly have a problem when we’re following the recipe for success.

 

And if we become aware of problems, we cannot admit to them because that would be admitting failure where others are succeeding – failing to enjoy our privilege and power, failing to handle it, etc. That’s one reason why the thought of working at Home Depot or giving up the tickets generates so much shame, even revulsion. (Note: Recognizing our feelings as valid and reaching a compromise is far better than forcing us into a work or housing setting to prove a point.)

 

It’s usually when suffering the physical effects from using or we dry out for a while, that we come to grips with the reality that the Myth is not working for us.

 

And you may find yourself behind the wheel of a large automobile

And you may find yourself in a beautiful house, with a beautiful spouse

And you may ask yourself – Well how did I get here?

And you may ask yourself, what is that beautiful house?

And you may ask yourself, where does that highway go?

And you may ask yourself, am I right…Am I wrong?

And you may ask yourself, MY GOD, WHAT HAVE I DONE?

 

The Talking Heads express what many of us feel as we begin to realize how much deeper our hole is when abetted by money, power, and status.

Our reality

How is the Myth supporting our use?

  • People close to us or helping us may look at our assumed power (or the power of those associated with us) and be afraid to confront us with our behavior.
  • If we are related to or associated with the moneyed, powerful, or famous, we may be so dependent on the connection for self-worth, livelihood, or recognition, we can never let go long enough to develop a life of our own.
  • Drug and alcohol issues are about managing the image of abstinence or recovery – not necessarily about changing anything.
  • It is hard to experience healthy pleasure (including sex) in relationships because of doubt: Is it me or my money/body/fame? Am I being star-screwed? Substances help us gloss over all these feelings.
  • While the well-off are able to afford household help, this supposed luxury is belied by physical/sexual abuse by child care assistants or other employees. Because parents are dependent on their help, parents are reluctant to take action or are “too busy” to pay attention to what is actually occurring with their children.
  • Professionals, such as school personnel or doctors, refuse to believe us, because we come from such good homes, and their careers could be jeopardized by filing a complaint.

Different life, new dream

Reflecting on personal experiences, tallying up the high percentage of relatives with addiction and mental health issues and talking with others from similar backgrounds, provides solid evidence the myth is a sham. There is no American Dream! But we can learn to live a different life with a new Dream.

Wealthy, famous, powerful, and addicted – Part V

Barriers to recovery: cultural and social rules

These rules act as breeding grounds for our addictions and prevent us from asking for help.

“What shows is what matters, and, above all, keep it in the family.”

 

In many settings, the very act of refusing a drink is viewed as being anti-social – so much so that when someone says, “No thanks, I’m in recovery,” common responses are: “You can have just one, right?” “Beer’s OK.” Or “Try this pill, it’s non-addictive.” Abstaining almost implies that anyone partaking has a problem, and that defies a heavily-invested-in norm – both literally (wine cellars and journeying) and emotionally (anticipating that drink or drug and conviviality).

 

The alternative of staying away is often viewed as an act of disloyalty, particularly for family summer or holiday gatherings, even though alcohol use is rampant and can awaken old using feelings for those trying to stay sober. And there may be a not-so-unspoken price to pay, when our economic wellbeing is dependent on family business employment or discretionary trusts. We may get a pass when first out of treatment, but many times we are simply expected to attend and tough it out, regardless of relapse triggers.

Examining social norms

One primary rule among wealthy and prominent families is that alcohol is served at every gathering. It is the social lubricant that allows many of us to function, connect with each other, and make our lives tolerable. (For the next generations, drugs serve the same function and are considered more socially acceptable than alcohol.) As Joanie Bronfman points out, this is one of many similarities between wealthy family culture and alcoholic family culture. Let’s look at others:

Our reality

  • The importance of maintaining appearances. What matters is what shows. What does not show does not matter.
  • Dress, manners, possessions, clubs, schools, activities, etc., show that one has money or is of privilege or power (can be counterculture as well).
  • Control and repression of feelings.
  • Limited interactions with people not like us. We’ve surrounded ourselves with “our kind,” going to the right schools, camps, colleges, living in the right communities, and associating with the right people.
  • A sense of entitlement. We believe we deserve what we have and expect to be treated differently than other people.
  • Judging ourselves in comparison with other people. This can be subtle or more direct, but comparisons often lead to feelings of superiority, based on what we have or who we are.
  • Expectations about appropriate work, mates, and social activities, which limit our individuality and creativity.
  • The message that we will be rewarded by our parents if we conform to their expectations as to how we should think and behave.
  • An emphasis on not showing off our wealth and prestige. Although some of us are ostentatious by choice – either deliberately modest or obnoxious.

And above all, when the going gets tough, we solve our problems our own way – thank you very much!

 

We learn social norms and rules as children, often by emulating role models or simply living a life organized around private schools, country clubs, camps, and second homes. The culture and expectations can be so internalized and stifling that we don’t speak our truth or have little idea as to what we want and who we are – a setup for the cocktail hour, joint, or pill taking on a life of its own. Handed down from generation to generation, this way of life is adopted by new entrants who are often unaware of the accompanying dysfunctions.

Save your face or save your ass

We can please our family and try to reclaim the veneer of respectability lost through our use, or we can recognize that committing to recovery means exploring, recognizing the limitations of our upbringing, and examining our delusions:

 

We live in the best neighborhood, our children attend the best schools, we support the best charities. Our family life is perfect – a credit to our family name… La-di-da.

 

When addiction strikes and it’s time to take a hard look at our lives and what needs to be changed to recover, breaking addiction means breaking the “rules.” It’s save-your-face-or-save-your-ass time; you can’t do both. Is what we tell ourselves, how we live our lives, and what we are told to do, working for us or contributing to our downward spiral?

 

Time to take a hard look at answering that question:

Sociability

A valued trait for fundraisers, parties, business, and volunteer work, gregarity doesn’t work in treatment. For those shy or uneasy with small talk, alcohol and drugs ease the way at these gatherings.

Happy hour medicating out of reality

Alcohol and drugs make it possible to remain in intolerable situations.

Speaking the truth is betrayal

Destroying the family picture that “life is good” feels like a betrayal of family and social class, no matter how ugly the scene is: neglect, physical and emotional abuse, incest, etc.

Women: deference begets abuse

Women are taught not to make a scene and do as they are told, resulting in a reluctance to respond to emotional and physical abuse, date rape, or guilt trips by outsiders. (Although this is slowly changing with new generations.)

Male dominance

The family and cultural imperative to produce a worthy male heir at any cost can lead to a sons’ dominance over sisters and toleration of “boys will be boys” behavior.

Believing I can do this myself

Individualism and the feeling of being on our own inhibit us from talking about our lives and asking for help. Our training about self-determination prevents effective treatment since we believe we “should” deal with the disease on our own.

What’s public is what matters

It is the public display of drunkenness that matters, not the private display. Thus, dealing with a drug or alcohol problem is figuring out how to limit the public display – not how to sober up.

Secrets take priority over connecting with peers and therapists

Keeping the family secrets is viewed as a valued act of personal loyalty, rather than as perpetuating separation between us, our counselors, and peers, who perceive our “loyalty” as distant and withholding.

A no-win situation

Keeping secrets is also a no-win situation: “I can’t talk about what it is like to be me. But I can’t get help if I don’t talk.”

 

Ultimately, it’s tough to maintain the appearance that we are fine when we are in a treatment center because our life is a mess and our use is out of control. But many prefer to ignore these facts, perhaps because the alternative is too scary and holding on to the outward manifestations of success is all we have left.

Escaping social rules and expectations? Or not!

“That ain’t me. I’m not a creature of my upbringing. In fact, I am doing things differently from what I learned as a child.”

 

You may say that. But not so fast. Family and past experiences are very influential, particularly when overusing drugs and alcohol or returning from treatment to the same environment but without our “helpers.” In these stressful situations, the ingrained behaviors and relationship ties, often at an unconscious level, take control and steer us into trouble spots. Too many cannot give up or postpone pre-recovery activities (e.g., the weekly lunch at the country club, fundraiser, hunting trip, etc.), and relapse is around the corner.

 

For those whose identity is centered on rejecting the rules, we often fail to recognize a real element of belonging is knowing what the rules are – whether we choose to obey them or not. This is a common experience for many addicts who perceive themselves as rebels or marching to a different drummer but who are still dependent on the monthly check.

Learning a new culture

As mentioned, this blog is about how cultural and social rules inhibit our recognition of addiction and keep us sick or in relapse mode. Learning a new culture – the culture of recovery – is key to overcoming the power of norms and expectations that perpetuate our disease. Other practices include building intuition (learning to access your heart and feelings, rather than the voices of others) and spirituality (connecting with a power outside of ourselves, not the expectations of others). Neither is a quick fix and both require almost daily focus to be successful. More on these topics in future entries.

Helping addicts stay the course

8 ways leverage works to improve outcomes

Today’s topic could be called “Why We Love Leverage.” That’s because we use it for many purposes, including compliance with treatment recommendations, signing releases, and drug testing. As mentioned in past blogs, programs for substance-dependent physicians use leverage for similar purposes and achieve spectacular results when compared to other approaches.

 

To refresh: A high percentage of people who need treatment do not believe they need it and do not perceive themselves as having a problem with alcohol or drug use. Therefore, they are resistant to being forced into treatment. Adopting a leverage-based approach allows the family, working with their professional, to adopt a long-term strategy to address the addiction, including chipping away at the self-perception problem over many weeks, if not months. Continued pressure provides situations for the addict to develop insight into the disease over the stages of recovery.

 

Currently, no treatment center offers the medical board model to non-physicians, so we adapt and modify their model. Here’s why leverage is needed and how it works.

1. To help the addict complete the stages of recovery.

A recent article in a professional addiction journal discussed the developmental approach to recovery and the six stages to achieving stable remission[1]:

  • Transition – Recognition of Addiction
  • Stabilization – Recuperation
  • Early Recovery – Changing Addictive Thoughts, Feelings and Behaviors
  • Middle Recovery – Lifestyle Balance
  • Late Recovery – Family of Origin Issues
  • Maintenance – Growth and Development

In our experience, this is a two-to-five-year process, depending on the progression of the disease, severity of use, and co-occurring conditions (trauma, abuse, learning, mental health, etc.).

 

Leverage becomes especially important in the second stage.

 

Stage Two: Stabilization – Five Tasks to Facilitate[2]:

  1. Achieving recovery from withdrawal.
  2. Interrupting active preoccupation.
  3. Creating short-term social stabilization.
  4. Learning non-chemical stress management.
  5. Developing hope and motivation.

These stages take much longer than 28 days, which is why leverage needs to be maintained over many months – and also why relapse is so common: Addicts leave treatment without being stabilized. (By the way, did your loved one’s counselor ever tell you where s/he was in the recovery process? I think not!)

2. To allow time for converting external motivation to internal motivation to recover.

Therapeutic leverage to enter treatment and comply with post-treatment recommendations is needed because it is very difficult for people with substance dependence disorders to change harmful behaviors on their own.[3]

 

The goal is to maintain pressure until the person develops sufficient internal motivation to want to remain abstinent and active in a program of recovery on his/her own volition.

 

Internal motivation to recover is a much stronger indicator for success than external pressure. However, because the degree of internal motivation is measured by acts and attitude, rather than talk and intentions, it takes time for internal motivation to “kick in” and show itself – again, usually more than 28 days, especially after relapses.

 

To be effective, leverage must be used with sophistication and discretion and is much more a carrot-and-stick proposition than raw force. For the affluent, leverage comes from controlling money, participation in family businesses, access to family resources, and relationships. Leverage is most effective if senior family members, trustees, or others in positions of power support its use and are united when dealing with an addicted family member.

3. To obtain full releases of information.

One key element in recovery is open communication among the substance user, treatment center, and key players in the addict’s life. Substance dependence lives in secrecy, with the person often leading a double life and understating the amount and number of drugs, when caught. Insisting on being informed on treatment of your loved one’s disease is not only good practice but sends the message that your relationship is now different.

 

Leverage is an effective tool for encouraging an addict to sign releases. It is indeed more than ironic that so often families pay for treatment and then a wall of silence is erected based on confidentiality laws.

 

Affluent patients often will sign only partial releases and withhold information about post-treatment recommendations if the recommendations defy the patient’s wishes. One way to counteract game-playing by addicts regarding the scope of the release is to request the treatment provider to send a copy of the signed release to the professional hired by the family, who will understand any limitations in the document.

4. To encourage signing recovery contracts.

These contracts specify activities the addict will engage in when leaving treatment, such as counseling, drug testing, meeting attendance, etc. It usually includes a relapse plan and an agreement to sign releases of information for all therapists, who must be approved as addiction specialists. In exchange, the contract specifies expectations regarding support by the family or trustee for recovery activities and lifestyle.

 

If the person leaving treatment does not agree to the contract, the family can refuse to support him/her or provide minimal support, depending on their level of comfort.

5. To encourage long-term compliance with all treatment recommendations.

Failure to comply with treatment recommendations is the No. 1 cause of relapse. If a person had cancer and all they had to do to recover was follow treatment protocols, they would do so without fail.

 

Substance-dependent people – who also have a chronic disease where there outcome is death or disability – commonly ignore advice from professionals and go back to their old ways. Leverage encourages long-term compliance.

6. To require effective and comprehensive drug testing.

This should not even be up for discussion, given anyone’s history with an addict. Not only is it very wise to condition support and access to family resources on regular, observed, full-screen tests (because addicts lie), but testing helps keep loved ones on the path to recovery because they know they will be caught if they use.

7. To allow early intervention in the event of relapse.

When combined with drug testing and a written agreement as to what to do in the event of relapse, leverage provides for fast intervention before a relapse gets out of hand.

 

One problem with people who relapse is they can do so for some time before others become aware of it. Then, they deny it happened, and if proof exists, claim it was a one-time occasion. This is why drug testing is so important: It is undisputable data regarding use. And it allows for quick interceding before relapse becomes embedded.

8. To increase consequences of use to make the disease real.

One major block to recovery for affluent, substance-dependent people is that they suffer few external consequences from their use of drugs and alcohol. Research shows that the more consequences a person experiences, the more likely they are to take their disease seriously and take action to abstain and recover. For the affluent, a key challenge is figuring our how to recover without losing everything.

Making the disease more real

By using leverage to accomplish the goals in topics one through eight, we are in effect Creating Consequences™ by making the disease more real: Drug testing, recovery contracts, and treatment compliance create accountability and require action upon leaving treatment. Along with the written plan in the event of relapse, it means that if the addict returns home and takes it easy – does nothing much regarding further efforts at recovery – there will be consequences. The hard work begins after leaving treatment, and leverage provides the foundation to encourage continued progress towards stable recovery.

References

[1] Recovery From Addiction, A Developmental Model, Part One, It’s All in the Journey, Sept. 2008, p. 8.

[2] Ibid, p. 12.

[3] Satel, Sally, M.D. 2006. “For Addicts, Firm Hand Can Be the Best Medicine.” The New York Times, Aug.15.

A myth is that the addict must be motivated to quit – that, as it is often put, “You have to do it yourself.” Not so. Volumes of data attest to the power of coercion in shaping behavior. With a threat hanging over their heads, patients often test clean.

Goodman and Levy. Biopsychosocial Model Revisited. p. 3.

Chemically dependent patients, free of co-existing mental illness, with intact jobs and family, tended to do well in rehabilitation programs if families and employers applied therapeutic leverage and support.

Susan Merle Gordon. Relapse & Recovery: Behavioral Strategies for Change. Caron Found. Rept. 2003: p. 18.

Internal motivation is a more powerful predictor of recovery than external motivation. Moving from external motivation to internal motivation is a long process. Therefore it is critical for external pressure to continue until this transition is fully underway, if not complete. The failure to follow this advice is a major cause of relapse (paraphrased from report).

Chuck Rice. “Impaired Lawyers Overcome Denial, Stigma to Achieve Road to Recovery.” Hazelden Voice. Vol. 9, No. 2. Summer, 2004.

My experience with attorneys tells me that long-term outcomes are dramatically improved when lawyers can be monitored and when there is an accountability system with a fair amount of external support.

Alan I. Leshner, Former Director, National Institute on Drug Abuse. National Institute for Mental Health. Science and Technology. Spring, 2001: p. 2.

Treatment compliance is the biggest cause of relapses for all chronic illnesses, including asthma, diabetes, hypertension, and addiction.

 

Alternatives to leverage

Other models to encourage change when facing addiction

 

As anyone who has turned to the Web and typed in “addiction treatment” knows, there is an ever-growing number of options that promise a cure. These range from doing nothing, to medication management, to insight therapy. The wide variety of methods may puzzle the reader who wonders why there are no “best practices” or a commonly agreed-upon professional approach to treating addiction.

 

The reasons for this lack of standards are threefold:

  • Unlike other areas of medicine, claims for success are completely unregulated by the FDA, FRC, or health department. So it’s a buyer-beware, anything-goes market.
  • No established criteria exist for evaluating treating outcomes.
  • Most addicts do not want to stop and so go to treatment that lacks rigor or effective protocols, despite marketing claims to the contrary.

In fact, there is a best-practices model, and that’s the therapeutic leverage approach (modeled after the physicians’ program), which we described in last week’s blog.

 

That blog also briefly reviewed the accepted medical view that addiction is, in part, a disorder of the autonomic nervous system where the urge to use occurs at the unconscious, limbic level. That’s the “loss of control” addicts experience over how much and when to drink or take a pill. We also discussed the lack of motivation to seek help and remain treatment-compliant for the many months needed to achieve stable sobriety.

 

So in thinking about other approaches, consider how they address these hallmarks of addiction:

  • lack of control at the unconscious level, and
  • lack of perception and motivation to seek help and comply with treatment recommendations.

Then evaluate how each one manages these concerns in comparison to the leverage model.

Doing nothing

Waiting until the addict wants help

Many families prefer not to use coercion (leverage) because they fear a negative response from the addict or want recovery to be the addict’s “choice.” However, because the addict’s disease results in the compulsive and harmful use of alcohol or drugs (see above), you will be waiting a long time for this “choice.”

 

Here is what a leading authority has to say:

 

A myth is that the addict must be motivated to quit – that, as it is often put, “You have to do it yourself.” Not so. Volumes of data attest to the power of coercion in shaping behavior. With a threat hanging over their heads, patients often test clean.

Sally Satel, M.D. “For Addicts, Firm Hand Can Be the Best Medicine.” The New York Times, Aug. 15, 2006.

 

Even after explaining how we apply the physician model to other groups and their success rates, some parents are reluctant to use pressure, saying,

 

“My son/daughter will be so mad, s/he will never talk to us again.”

 

Anger and rejection are transitory threats made by the addict to preserve the status quo. A good counselor will help you manage these responses (and take some of the heat).

 

Without leverage, all the love in the world will not sustain recovery. (By the way, we do advise using leverage or the implied threat of leverage in a respectful and loving manner.) But doing nothing and waiting for a serious enough consequence is not an option. The risks are too great.

 

‘Letting go’

Common practice from Al-Anon, therapists, and counselors is to tell family members and their advisors to “let go” and not try to affect or “control” an addict’s use or recovery. This is not a successful recovery model because the addict is often suffering serious economic, emotional, and physical harm, with the attendant damage to family members, particularly children.

 

For the affluent, dangerous use can go on unabated, with few consequences, until late-stage alcoholism, overdoses, or nonstop use.

 

In our view, letting go or waiting for the addict to choose to enter treatment is, in fact, neglect because addiction – by definition – is loss of control over the decision to drink or drug.

 

Letting go does not honor autonomy because, at some point, the autonomic, unconscious part of the brain will override any vows to stop.

 

As one beneficiary said to me, “How come nobody tried to help me when they could see I was way out of control?”, after 20 years of hard use. 

Medication management

Craving-reduction medication

Naltrexone is an anti-craving drug designed to help alcoholics reduce their alcohol use and to prevent relapse. It can be helpful, but only as part of a comprehensive recovery program; it is not sufficient on its own to lead to stable recovery. If used, it needs to be combined with effective treatment.

 

Substituting one drug for another

Several well-advertised treatment programs substitute benzodiazepines (e.g., Xanax and Klonopin) for alcohol and hard drug use. These prescription medications are known as “alcohol in a pill” and users are simply swapping one addictive substance for another.

 

Similar considerations apply to “herbal remedies,” such as ayahuasca and rue seed, which are touted to cure addiction but affect the same areas of the brain as other hard drugs.

 

Suboxone is given as an alternative to opioids, such as OxyContin, because it results in a lesser high and stays in the body longer. Similarly, methadone is prescribed as a substitute for heroin. The problem is that users are just as dependent on the substitute drugs and will usually return to their former drugs when available. Another huge concern is that there is a large resale market for the substitute drugs because prescriptions are loosely monitored.

 

Anti-use medication

Drugs such as Antabuse have been used since 1951 to help people stop drinking by making you sick to your stomach if you have a drink. If you know you can’t drink, then you won’t think about drinking as much. This is an example of an external control designed to remain in place until the person develops sufficient internal motivation to achieve recovery. The problem is that many people on Anatabuse stop taking it or drink while on it and never reach the next phase.

Insight-based therapy vs. stopping the addiction first

Some therapists and treatment centers believe the addict needs to resolve the underlying conditions (i.e., the mental health, social, or other factors) leading to addiction before recovery can take place.

 

This belief is completely incorrect, not supported by research, and views addiction as a disease secondary to the underlying issues.

 

Addiction is a primary disease that needs to be addressed first, in that the addict needs to be detoxified and in the first stages of recovery before delving into the “drivers of addiction.”

 

I know addicts who see their psychiatrists two or three times a week for years and never stop using drugs. (Nothing better than an addict with money to keep on paying for therapy!) Addicts will give 100 reasons why it’s hard for them to stop and claim that if they can just get them resolved or gain more insight, the problem will be solved. This is all part of their smokescreen to keep on using.

Moderation management

This approach is designed to help people reduce their drinking (or drugging) to a manageable level where they are no longer binging. The goal is to still enjoy a beverage or a pill without the hangover or negative impact on work or relationships and to socialize without the stigma of being a non-drinker or – God forbid – an alcoholic.

 

If a person truly has a substance use disorder and the attendant brain change, it’s nearly impossible to exercise the control needed to maintain reduced use. This means at some point, there will be a return to prior use levels and that can be very dangerous, depending on when and where it happens.

 

Let’s face it: People drink to get a buzz on. So it’s no fun only to have a drink a day. (Or maybe it is, depending on the size of the drink.) Many “restrictors” are unpleasant to be around because their bodies “thirst” for that next drink, and the amount of willpower needed to stop at one makes them angry and bitter (i.e., “Why did God take away the only pleasure I had in life?”).

Assessment/evaluation model

This model is based on the idea that there is unsettling conduct, behaviors, or emotions on the part of the loved one, but uncertainty as to what may be the cause. So the person of concern is asked to obtain an evaluation or assessment – either outpatient or inpatient – to get a better picture of what is going on. Great idea, but your loved one has to agree, and then there is the debate about the type of evaluation, where it should be held, and who will be sent the results.

 

This segues into another phenomena: the addict who goes to treatment intending to stay awhile and then being “discharged” before completion, either due to disruptive behavior or leaving AMA. The addict is changing the attitude of his/her parents by ostensibly complying with their wishes but really is only going through the motions, with no intention of doing the internal, emotional work that recovery requires.

Drug testing

The success of all of these models is dependent on addicts being truthful about their use. As addicts lie, the only way to know what drugs are being taken is through drug testing with a competent service. Most users these days are taking multiple drugs but may only admit to one or two less-serious ones – alcohol and pot, for example – when they are also on benzos and ecstasy. Drug testing is a change technique in that it provides information about what is really going on, so the family and the user are on the same page. Also, drug testing, when combined with these various models, should lead to better results – either showing the need to intensify efforts or move to a more leveraged approach.

None as successful as leverage

None of these strategies is as successful as the leverage-based physicians model. Without the help of family and friends, the addict will continue to suffer as the disease progresses.

 

For families, the options are not leverage or choice – they are leverage or neglect.

 

Your addict needs encouragement to seek help, and this requires working with a qualified counselor to strategize and create a plan to address and manage the disease over the long term.

 

Our next blog will detail the benefits and fine points of using leverage.