Examining Distorted Beliefs Related to Substance Use, Part 3 - Intervening in the Addictive Cycle

May 15, 2011 12:55 PM | Anonymous
By Graeme Daniels

This article is presented in three parts. Part 1 Part 2 Part 3

Some time ago I worked with a father and son who were struggling to communicate regarding the son's substance use. The son, Eddie, 18, had been living with his father, Mike, for two years, following his parents' divorce six years earlier. Eddie had begun using drugs (notably alcohol and marijuana) at age 14, and exhibiting defiant behaviors at home and at school. After Eddie completed a ten-week outpatient treatment intervention, father and son were referred to me for therapy.

Eddie presented as motivated to change his behavior, but was consumed with anger about his father's distrust of him. "He never believes anything I say", he'd complain, to which the father would retort, "You don't give me reason to." Both Mike and Eddie agreed that they wanted to regain mutual trust, but they were locked in a cycle of mutual blame.

Mike occasionally pretended to trust his son in order to de-escalate conflict, but ended up disillusioned whenever Eddie relapsed. Eddie ended up guilt-ridden. I asked the father and the son to each take responsibility for their own thinking, feeling, and solutions and to set a realistic foundation for the rebuilding of trust.

Eddie and I focused on identifying his problematic thinking, and redefining his ideas about risk-taking. He was aware of the risks associated with drug use: Eddie had been both arrested and suspended from school for intoxication- related offenses. When asked about the risks associated with sobriety, and the acceptance of his father's house rules, he struggled with feelings of resentment and was unable to imagine how his life might change for the better. Gradually, Eddie acknowledged the fears that lay under his resentment: abstaining from drug use might lead to loneliness and loss of friendships; accepting his father's rules meant losing his freedom and the adult image he craved.

On a deeper level, Eddie's distrust of his father stemmed from the divorce of six years earlier, when Eddie's life was thrust into turmoil, his parents' needs seemed to take priority over his own.

In reframing trust-building as a task for Eddie as well as for his father, I was able to persuade Eddie to accept a series of agreements that included (1) submitting to urinalysis testing at his father's request and (2) accepting material consequences (withholding of money, for example) whenever he relapsed. Having good intentions would not mitigate the consequences; if Eddie reached a "contact high" from someone else's use, or received a positive drug test result after unwittingly tasting a drink that was "spiked," the consequence would remain the same. When Eddie bristled: "That's not fair," I reminded him that his body and brain would respond the same to exposure to a drug regardless of his notions of fairness.

A second series of agreements presented a particular challenge to Mike. In conjoint therapy, Mike spoke of his feelings of guilt as a parent. His inconsistent parenting and controlling tendencies: name-calling, impulsive imposing of consequences, and distancing interpretations of his son's behavior ("I think you use to escape from your feelings!") masked a deep feeling that he and his ex-wife had let Eddie down. I suggested to Mike that he seemed as impulsive and conflicted as his son and that his behaviors were inadvertently reinforcing his son's negative behaviors.

I worked with Mike to focus on consistently and calmly following through on realistic limitsetting. Trust could not be based on an anxious belief in his son's latest promise, only to be followed by blame. Father and son were to commit to eliminate bargaining over the fairness of consequences of the son's drug use: the relapse of a friend, the father's controlling behavior, or other stressors, could no longer justify relapse. Further, each committed to seek out separate support systems for the processing or venting their feelings, so that they could avoid directing judgements at each other.

These agreements allowed for father and son to understand that trust is a bond that develops and evolves through ongoing attention and care, not something to be taken for granted. They allowed father and son to navigate past mutual blame, and made space for each to sit with their uncertainty and discomfort - without resorting to substance use on the part of the son, or rigidity on the part of the father.

Over the course of therapy, there were relapses on either side. Eddie often tested his father's curfews, demands for phone "check-ins," and chore assignments; he used drugs on numerous occasions, and generally manifested his contempt for Mike's parenting. Mike gave frequent voice to frustration, often characterizing his son's relapses as a form of betrayal. As time passed, the structure provided by agreements allowed father and son to explore and change their values, and challenge the beliefs that perpetuate thecycle of drug addiction.

Mike and Eddie terminated therapy after about a year. At that time, Eddie had been clean for 90 days and wanted to focus more on twelvestep work. Mike has sent me Christmas cards the last three years, and Eddie has contacted me as well. Their relationship, though not perfect, has improved. Eddie has grown to see the connection between being truthful and gaining trust and is invested in truthfulness as a value for himself. Mike is more willing to take responsibility for his feelings of guilt and inadequacy, instead of externalizing them or blaming his son. Ultimately, Eddie moved out of his father's house. Without the intensity of cohabitation, Eddie is more able to pursue the tasks of individuation, and Mike the task of letting go.

References

Gorski, T. (1989) Passages Through Recovery: An Action Plan for Preventing Relapse. Hazleton: Center City, Minnesota

Miller, M.& Bakalar, JD. "The adolescent brain: Beyond raging hormones." The Harvard Mental Health Letter, July 2005, 22(1).

About the Author

Graeme Daniels has been facilitating support groups and psycho-educational groups for over twelve years. He currently leads men's support groups at the Impulse Treatment Center in Lafayette, California. In collaboration with founder/owner Don Mathews, MFT, the groups address issues of sex addiction and couples' relationships. Graeme is also currently the supervisor of the intern program at Thunder Road Adolescent Treatment Center in Oakland, California, which specializes in substance abuse issues. Meanwhile, he is also in private practice in Pleasant Hill and has worked with adults, couples, adolescents, and families dealing with substance abuse as well as sex addiction.

Visit Graeme Daniels page on this Website.
 

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