A. Tom Horvath, Ph.D., ABPP
1) Stay focused on the desired outcome, not the process. You may be hoping to find the “right” treatment for a loved one. Rather than insisting that your loved one do this or that (some treatment program you think will be helpful), focus on what you really want: no more (or at least fewer) addiction problems. Don’t get so caught up in the process of treatment that you lose sight of the goal. Let your loved one determine what might be helpful. Any program the user chooses is better than one forced on him or her.
Starting with local outpatient treatment often makes more sense than going off for 28 days to residential treatment. In many cases simply entering individual psychotherapy will be sufficient. Don’t hold your loved one accountable for going through the motions of change. Actually stay focused on the outcome you desire. In other words, “I’m going to treatment just like you wanted me to” should not be allowed to excuse misbehavior.
If it is available in your community, sign yourself up for CRAFT (Community Reinforcement and Family Training). These sessions will teach you how to take care of yourself, reward positive behavior in your loved one, and induce your loved one to enter treatment if it is still needed.
Remember also that change without treatment is entirely possible. Treatment centers rarely say this (it’s not good for business), but it’s an easily made observation. Smokers rarely attend treatment to change, but tens of millions of US residents have quit smoking. Is it easy to quit smoking? Of course not! You might object that intoxicating substances are different that cigarettes. To a degree, yes, but many who have quit cigarettes and also a more intoxicating substance report that even though the intoxicant was more fun, the cigarettes were harder to stop.
So, stay focused on the outcome you want, and let your loved one focus on how to get there. Also, do not hesitate to establish timeframes for the changes needed. Otherwise you may hear “I’m working on it” for a very long time.
In some cases insisting on drug testing to confirm the change may be useful. Mon-Wed-Fri drug testing is a frequency that will catch almost any substance use, including alcohol if you use the new EtG test. However, the EtG results need to be interpreted carefully, so seek appropriate guidance.
2) Expect to make some changes yourself. It is not accurate to think that “if he/she would just change then everything would be ok.” The way to change the behavior of others is to change your own. For your loved one to change his/her addictive behavior may require significant change in your behavior. Are you ready to maintain communication and a loving attitude, but set firm limits about certain behaviors? This is not the same as “tough love.” Some families have used the tough love approach (“come back when you are fixed”) and seen disaster occur. For instance, if you kick your child out, how will you feel if homelessness leads to being beaten badly or murdered? In many cases the place for the family to start is with their own treatment, to gain the strength to maintain the balance just mentioned: communicative and loving on the one hand, but firm on the other. Quite simply, if your perspective is “it’s his/her problem, I’m not the one who needs treatment,” perhaps you are not truly ready for the change you say you want? The right firm limits are often rather difficult to establish. There is no shame on seeking professional help to figure out the big picture: what you should reward, what you should ignore, and what you should set boundaries about.