Getting Help: Drug Addiction Series Part II
Second in a series of expert interviews.
by Kim Duffy
If your son came home from basketball practice with a badly swollen ankle, and you couldn't tell whether it was seriously injured, wouldn't you take him to the doctor or to an emergency department to find out the extent of his injury? Most parents would say yes. So, when that same parent notices that their son appears ill and they fear he may be tampering with drugs, why do they feel that they are responsible for diagnosing and proving the problem before taking him to the doctor?
Kelly Lundberg, PhD, is one of many professionals whom parents can call if they suspect their child is abusing drugs or alcohol. She is the director of Assessment and Referral Services, where people can come for an assessment of potential drug problems, and also get a referral to an appropriate treatment program. This county-funded agency can offer objective assessments because they aren't selling treatment programs. They also offer support groups six days a week for people who have been assessed and are waiting to get into publicly funded treatment.
Dr. Lundberg spoke with me about how and when to get help for addiction.
Why do clients need to be evaluated? Can't they just show up at an emergency department, or call a private recovery program and ask to be admitted?
They can. But the benefit of having an evaluation is that we look at all the issues going on with the person, then match the appropriate treatment. Not everybody needs residential treatment. Not everybody needs outpatient. Secondly-who can best meet their needs? If you're a woman with a two-year-old child, there are certain places where you can bring a child. Or if you are somebody with a history of sexual abuse and it's really driving your addiction, you need to go to a program that will address those issues.
Where can a parent find information on private and publicly-funded programs?
The Salt Lake County Division of Substance Abuse Services: 468-2009
Substance Abuse & Mental Health (SAMHSA):
Valley Mental Health: 261-1442, www.vmh.com
The Callister Foundation helpline: 366-HOPE, www.hopetoday.com
Utah Psychological Association: 359-5646 firstname.lastname@example.org
If parents can afford treatment, should they still call Salt Lake County Substance Abuse Services for advice?
Yes, and there are plenty of parents who have the ability to pay but still don't know where to get treatment. So just finding out more about the system, understanding for instance that county-funded agencies also take private pay, is good information to have.
Is there good public addiction treatment in this valley?
There is great treatment. Some of the best, most innovative treatment in the country is here. When people who run the county division of substance abuse go to national conferences, people come up and ask them how to set up these programs.
How do parents choose a private treatment program, which can cost $10,000-$12,000 per month for residential?
They can look in the yellow pages, call their insurance company, or ask friends. Visit the facility and ask them these 10 questions (see the CATALYST website). People tend to think that expensive is better. You may just be paying for nice digs.
I see from your 10 questions that research shows treatment needs to be at least three months in length. I guess the parents have to decide if they can pay $30,000 for the first three months, which may be only the first of several treatments needed. I'm beginning to see why an assessment and referral makes sense.
What if there isn't time to look at a website-how do parents identify an emergency?
That's the other myth. It's okay if you don't know whether it's an emergency. Be cautious. These are life-threatening problems, and it's okay to overreact. It's better than underreacting. Parents struggle with the stigma of addiction and that may make it more difficult for them to go to the hospital-but they need to get over it.
Which drugs have the most potential for overdose?
Opiates (heroin, OxyContin) are extremely dangerous and easy to overdose on. If the addict has been clean for a while and goes back to using again, their tolerance has changed and [the same amount] can kill them. Or if a new, purer batch is on the street, there is a great potential for overdose. But they can overdose on anything; you've heard about those athletes who had heart attacks from too much cocaine. It's rare with stimulants but it's possible.
What if a parent has a child who is withdrawing or is psychiatrically unstable?
Take them to the nearest hospital. You don't want to mess around with that. People underestimate alcohol withdrawal. More people die of alcohol withdrawal than any of the other withdrawals combined. If somebody's having seizures or hallucinating they need to be in a safe environment. Benzodiazepines (Xanax, Valium) are another dangerous withdrawal. They have to be tapered over a period of weeks. The other withdrawals aren't dangerous. Nobody dies of cocaine or methamphetamine withdrawal. You really can't treat those medically; they don't require inpatient hospitalization. Heroin withdrawal isn't medically dangerous, but it's an awful, awful withdrawal, like the worst flu you can imagine times 10. Heroin becomes a withdrawal-driven habit; addicts use it just to avoid the withdrawal, not even for the high.
What are the factors you consider when evaluating and referring a patient?
Ability to pay comes up right away because if they have no money, they're not going to get into treatment for three to four months, and we need to offer them interim care. Then we consider gender, length of addiction, risk for withdrawal, other health conditions, mental health issues, motivation for treatment, relapse potential, social support system, and employment status, to name a few.
Which of these is most fraught with difficulty?
Their motivation. If people stay in treatment they get better; we know that. Keeping them in treatment is the hardest one to struggle with.
What do you tell parents with minors who are unwilling to enter treatment?
With minors, parents can force treatment. We used to think that people only benefited from treatment if they really wanted it. But that's not the case.
Or you had to wait until they hit bottom.
Exactly. But if they are a minor, you don't wait. It doesn't matter if they don't want to go; you take them anyway.
What do you tell parents who bring in their adult children who are unwilling to enter treatment?
What I get to do, because I don't provide treatment, is I barter, I beg, I plead. I tell them to try it for three sessions and see; they can always change their mind afterwards. If they flat-out refuse, and I've only had that happen once, then I talk more with the parents about what they can do.
What incentives can parents offer adult children?
Typically these adult children are struggling, financially and otherwise. Some parents allow their children to live at home if they're in treatment. They can buy their groceries-I don't suggest they give them money. They can pay rent, but there have to be conditions, and they must continually re-evaluate.
Should they provide them with transportation or cell phones? I've heard about one set of parents who paid for their daughter's breast implants to improve her self-image which was flagging, they believed, because she was an addict.
I don't recommend breast implants. Cell phones, cars-whether it's an addiction or not-these things are privileges, and there should be consequences if the agreements aren't met.
Are there programs for parents whose children won't try to get sober?
Programs like Al-Anon, Recovery Anonymous, or they can dial 211 for resources. Some people see their private therapist. This can cause a lot of strain on a marriage, so marital therapy can be critical. Mom and Dad don't typically agree on how to handle a child's drug problem. Many of the things we're taught to do with addicts seem like the antithesis of parenting.
What do you do with those who relapse continuously?
Keep putting them in treatment. You don't give up. I knew a guy who got sober after 14 treatments! You wouldn't tell a diabetic: "I'm sorry, you've had seven sessions. You don't get any more treatment for your diabetes."
Is there an updated version of the warning signs? Changes in friends, dodgy behavior, sleeps too much, pupils too big, pupils too small-these seem a bit vague.
A lot of those things are typical adolescent behavior anyway, and some aren't going to display until the child has a full-blown addiction. One of the strongest indicators I've found is if the parent has a gut reaction that their child is in trouble-and then they have that gut reaction again- they should pay attention.
Kim Hancey Duffy is a freelance writer living in Salt Lake City.