When someone in your family is dealing with an addiction disorder, it’s hard not to feel every painful emotion all at once — anger, guilt, rage, sadness, helplessness. Today we hear from a father who is trying to get his son to accept therapy and a mom who is at the end of her rope trying to break the cycle of her daughter’s alcoholism. So, what can a family do? This week, Nzinga answers questions about how to help those in your family and how to help yourself.
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Other resources mentioned in the show:
- Eleanor Health Blog: How Do Families Get Help
- SMART Recovery for family and friends
[00:01] Dr. Nzinga Harrison: You are listening to In Recovery, which is a Lemonada Media original podcast, and we have a super short listener survey open right now. We’d love to hear from you. Go to LemonadaMedia.com/Survey and tell us about yourself. Share your feedback on In Recovery. And I promise you, this is anonymous. So tell me what you are really thinking. If you complete the survey, you have a chance to win a $100 gift certificate from Lemonada.
[00:46] Dr. Nzinga Harrison: Hello, everybody. Thank you for listening. I’m Nzinga, and this is In Recovery, a podcast about all things addiction. We talk about drugs, alcohol, opioids, marijuana. Every drug you’ve heard of for sure, but also things that we wouldn’t necessarily think of as addiction, like gambling, sex, exercise, work. And I’m your host because I have a long track record of being an expert in this space. So I’m a physician, a psychiatrist and addiction expert. I’ve been practicing medicine and taking care of people affected by addiction for over the last decade and a half. I believe in it so much that I’m co-founder and chief medical officer of this incredible company called Eleanor Health, where we take care of people affected by addiction. And maybe even more important than my street cred that I just laid out for you is that I’m a human. I’m a wife. I’m a mom, a sister, a daughter, a friend. And so the format of this show is question and answer. What I’m really hoping to do is give some education in a compassionate, non-stigmatizing way about addiction, and break down this false barrier of the idea that there is a them and us, because it’s just all of us.
[02:01] Dr. Nzinga Harrison: So you call in with your questions and we will answer them here on air. This week, we are talking about addiction in our families. We’ll hear questions from a mom and a dad of two adult children who are struggling with substance use disorders, and their kids are at different phases in the illness. So some of the things will be common for the dad, whose son is in early remission, and the mom whose daughter is still in active phase and using, and some things will be different. After we talk about those two adult kids, we’ll get into a question about what to do in a worst-case scenario, when safety is at risk. Before we do that, remember what I said up top? This is a question and answer show. So thank you to this mom and dad who sent us in their questions because you are helping us get the word out. You, too, if you’re listening right now, can send us your questions. And we need you to send us your questions. So how do you do it? Call us at 833-4Lemonada. That’s 833-453-6662, and leave us a voicemail. If that’s not your style, you can totally fill out our contact form at bit.ly/inrecoveryquestions.
[03:33] Dr. Nzinga Harrison: In a couple of weeks we’re going to talk about guilt. So if you’re a family member, a person who’s currently using, a person in recovery from addiction of any type drug or otherwise, or anybody who’s working through any guilt that has something to do with addiction, we want to hear from you. Send us your questions and we’ll talk it through.
[03:55] Claire Jones: And one last note before we hop into the show. A small story, an anecdote, if you will. So after the Fourth of July weekend, which also was right after I was on vacation for a week, Nzinga and I got together and recorded a great episode, a fabulous episode, and then we realized that the mic wasn’t plugged in to the recorder. Because it turns out, in addition to being brilliant, Nzinga is, like she said, a real human. So luckily, we recorded our Zoom audio and that’s what we’re using for this episode. Apologies in advance that it’s not up to our normal standard. But listen, that’s production in the time of corona.
[04:36] Dr. Nzinga Harrison: Hello, everybody. Thank you for listening. I’m in Nzinga and this is In Recovery. This week, we’re going to talk about families dealing with addiction. And so, you know, my whole thing is hopefulness and compassion and being able to look at addiction not through kind of like the death dirge, everything is always awful lens. But the fact of the matter is that, listen, with this illness, like other illnesses that ravish and steal people from us, sometimes it’s awful. And so we have to get into that because we have to figure out how to try to survive those periods that are awful, and how to protect ourselves emotionally while being there for our loved ones who are suffering, or if it’s yourself that is suffering. And so we’ll spend some time near the end of the show talking about worst-case scenario and how to make it through that as well. So, let’s start with a voice mail.
[05:40] Claire Jones: So our first voice mail is coming from a dad of a 19 year old who is currently living in recovery from marijuana and cocaine substance use disorder. He went through a pretty prolonged cycle of substance use, treatment and relapse. And eventually Bill and his wife kicked their son out. He ended up in sober living, and initially Bill reached out because he was worried about the trauma that his son was being exposed to and sober living. But now his son is doing pretty well. And Bill’s new concern is that his son is not interested in therapy. So let’s play just a little bit of his voicemail. And then we’ll hop into questions.
[06:19] Bill: The question I had for Dr. Harrison is really just some insight as a parent, a professional, a psychiatric addiction specialist, for anybody like myself, specifically a parent going through this. I’m in Alanon, I’m getting help to make sure that I don’t weaken my boundaries and I don’t enable, and I limit the codependency that I have. So I’m seeking advice from you., Dr. Harrison, on how to continue and what avenues I should continue to offer for him. I don’t know that that can even be answered, since we’ve offered therapy and he refuses it. But just some insight with your experience would be very helpful to me as a dad. And thank you very much.
[07:15] Dr. Nzinga Harrison: So thanks, Dad, so much for sending in this voicemail. I always love it when parents in particular, but loved ones in general, feel so deeply that they pick up the phone to ask for help or send in an email to ask for help. So that’s number one, is that I just want to really give you the positive reinforcement for taking this step, because I know that it’s not easy and it can be scary. To get into your first question, which is really just some insight as a parent, specifically for a parent going through this. I love to see that you’re in Alanon, which is amazing. Because the first thing, if you’ve listened to other shows that you’ve heard me say is like you need your own support. So even though you are not the person with the addiction, you are experiencing the fallout from the addiction. You have the pain that goes with the addiction. You have the uncertainty, the fear, the wondering. And there’s actually medical research that shows us the fear and anticipation of bad news that a parent of a child with addiction lives with is affecting your day to day. And I know that I don’t have to say that to you, Dad, because you’re living with it every day. But the reason I say that out loud is, in case you thought you’re the only one living with that, and in case anybody else is listening, that feels like they’re on an island with that sense of fear and dread that they live every single day because they have a child with addiction, you’re not the only one and you’re not on an island. And so Alanon is huge. I would also point you to — and I think we probably put this resource in the show notes almost every week. But Claire, let’s make sure we put it in again this week, which is WeTheVillage.co.
[09:15] Dr. Nzinga Harrison: We The Village is one of our partners and a resource that I absolutely love. It is actually founded by a woman named Jane, whose significant other had active addiction. And as he was going through his treatment process, she was cut out. And she was like, I need support. Where’s the support for me? And she started this village, which is a village of loved ones, some of whom are in the beginning of the process, some of whom are further on in their experiences. And it’s a village supporting you where you can ask your questions, get your questions answered. They have moderated sessions. The content is there. But literally, from the moment you dropped on that website, you will know that you’re not on an island because you will see people, parents who are having your same experiences, wives, husbands, fiances, brothers, sisters who are having your same experiences. And it’s like, what did you do in this situation? Does anybody have anything that can help? And so the same way you sent me your question, you could ask your question on that website and get experiences from people who have actually been through it. And some of them will say, like, this is how I did it, and that did not work. I do not recommend it. And others will say, this is how I did it or this is the resource that was really helpful to me. And so it’s a beautiful village and community.
[10:52] Dr. Nzinga Harrison: But I want you to take this up a notch, Dad. A number of parents of kids, whether young teens like your son developed his addiction younger, or older adults, these kids are always our babies, right? No matter how old they get. And so the amount of stress and anxiety and depression and fear that my parents with kiddos with addiction experience really lead you to needing your own support and your own path of recovery. So please get yourself a therapist. And this might surprise my parents who are listening, but like I literally want you to have a comprehensive assessment for your own depression, anxiety, any other physical illness, any other mental health need that you might have. Because what do I say every week? The risk for addiction and substance use disorders is partly coded in our DNA. So when I hear from you that your son developed his addiction early, around 16 years old, I’m automatically thinking, is there some underlying risk? Is there some underlying depression, especially around 15, 16 year old is where we see a lot of depressive disorders and anxiety disorders begin. Is there any of that underlying? And are mom and dad dealing with any of that?
[12:30] Dr. Nzinga Harrison: And so please get your own therapist, get your own comprehensive assessment, have support ongoing in place for yourself, because this is not easy. It is painful. And even when you’re in a period right now, like your son right now his substance use disorder is in remission. And it’s amazing. And it feels good. And you’re so grateful. And you’re so hopeful. And you want to celebrate. But I know, I can hear it in your voicemail, that fear that what else might be coming is underlying that. And so what therapy for yourself — and it may be individual therapy, may be couples therapy, even though he refuses at this point to go to an individual therapist, he might agree to go to family therapy. Even as you see an individual therapist, some of the work that you do in individual therapy is how to hold onto your hope and how to manage that fear of relapse, which I know is there. I can hear it in your question. And even if you hadn’t asked me the question, I would have known it was there. So now that I hope that I have convinced you, Dad, to get your own individual therapist, then let’s roll a little bit into education and then I’m going to talk about how to approach your son, because it sounds like maybe he’s not open to therapy or other interventions right now.
[14:01] Dr. Nzinga Harrison: What I really want to do is orients us on this idea of addiction as a chronic medical illness and what that means. So, you know, whenever I get into this part, I always take it out of addiction because it can be a little easier. And let’s put it into cancer. The reason I put it into cancer is because cancer is what we call in medicine, a relapsing remitting illness, addiction, substance use disorders are also relapsing remitting illnesses. The other reason I put it into cancer is because cancer is emotionally awful and scary, and we often feel like we don’t know what to do. And in periods of remission, we have that fear of relapse for cancer. And so I’m drawing all of these same parallels to addiction. The difference between cancer and addiction is because cancer is so physical. It’s easy for us to divorce the symptoms of cancer from the individual person. Our brain doesn’t mix those two together. And so when cancer is bringing symptoms that are awful and we see it killing our loved one and it’s taking a toll on our family and it’s using up all of our emotional resources, it’s very easy to know that that’s the cancer that’s doing that as opposed to the person who is doing that. On the other hand, symptoms of substance use disorder are personal, right? It’s behaviors, it’s feelings, it’s the way your son treats you, it’s the way your son responds to you trying to reach out to help him. Even though all of those are symptoms of the substance use disorder, it’s very difficult for our brains to separate out those symptoms from the person we love.
[15:54] Dr. Nzinga Harrison: And we can get kind of mixed up and think “this is the person I love,” as opposed to “this is the illness that the person I love has.” And so bringing it back to cancer, the reason we say in medicine it’s relapsing and remitting is because there are periods of time where you have symptoms, and they’re out of control, and that is what we call a relapse. The symptoms of the illness are out of control. The illness relapsed. You go through chemo, you go through treatment, you get your medication, you get your radiation, and the cancer goes away. And it is during that period of time, your illness is considered to be in remission. Your cancer is in remission. When we have people who are in remission from cancer, our idea is not that it is cured and forever gone. Our idea is that there’s a formula we’re working to try to keep that cancer away, but we’re also constantly surveilling for signs that maybe the cancer is coming back.
[17:01] Dr. Nzinga Harrison: So if I’m talking about breast cancer, that would be, for example, if you’ve never had breast cancer, you get an annual mammogram. If you’ve had breast cancer, you get your mammogram more frequently than that, you’re doing your monthly breast exams, you’re taking your tamoxifen, which is a medication. There’s an entire formula dedicated to keeping that cancer in remission. The exact same pattern is true for substance use disorders and other addictions. While the symptoms are active, so it’s using the drug, it’s maybe being volatile, it’s maybe lying, maybe sneaking, maybe stealing money, maybe not being able to work, maybe being difficult to be in a relationship with. All of these are the symptoms of the substance use disorder. When those are active, we call that relapse.
[17:59] Dr. Nzinga Harrison: Now, the way we get confused is that we say the person has relapsed. It’s the illness that has relapsed. And then like your son is right now, when those symptoms go away, is the period of remission. So he’s not using, he’s living independently. Sounds like you guys are working on repairing your relationship. The substance use disorder is in remission. Just like with cancer, we have to do that surveilling, looking for early signs that the symptoms might be coming back, helping to figure out what that magic formula is. And so at the seat of your question is my son is refusing to work a formula. And what I want to give you a little bit, maybe a change on the lens, is that we think the formula is the same for everybody, when, in fact, the formula for keeping a substance use disorder in remission is different for everybody. We know the common thread for that magic formula is connection, life meaning, participating in activities that actually bring a feeling of meaning and purpose, also being responsible for someone else. And then we go to our biological, psychological, social, because you’re right, if there need to be medications, if there needs to be psychotherapy and then keeping stress low.
[19:29] Dr. Nzinga Harrison: So what I want you maybe to take a different approach with your son is to ask him, what do you think the parts of your magic formula are? I listened to Dr. Harrison on this podcast, and she said, the three things that are in everybody’s formula are connecting and nourishing relationships, life meaning and somehow being responsible to somebody else. What are those parts of your formula that you are working? And then Dr. Harrison also said sometimes we need medications to help keep it away, and that might be medication for the addiction itself. That might be medication for depression or anxiety. She said sometimes it’s psychotherapy, that might be individual, couples, family, group, but it’s always trying to keep your stress low. And so of these six buckets, which buckets are you dipping into for your formula? And how can I support that?
[20:32] Dr. Nzinga Harrison: Because it may be that your son can put together a magic formula that doesn’t have therapy. I think a lot of times where we stumble and fall — and this is especially because your son is 18, which is still adolescence, which is still like, “mommy and daddy don’t need to be telling me what to do with my life.” Is we come to them and say this is what you need to be doing. And they say no. And then we feel a little defeated, like, oh, man, that was the only tool I had in my tool box. And so what I hope I’ve given you is kind of like five other tools to put in your tool box. And then the last thing I’m going to finish up with, which is circling back around where these buckets overlap is him being responsible somehow for goodness and health in somebody else’s life. And so it may be that you can say, “this is so important to me, like I’m in my own therapy to figure out how I can best support you through this, and how I can stay emotionally whole so that I’m there for you when you need me. I would love it if you came to a couple of my sessions with me.” It’s a different take, right? It’s still getting him in therapy, but it’s getting him in therapy through that pathway. That is him being helpful to you, as opposed to you’re going to therapy because that’s what somebody said you’re supposed to do when you have addiction.
[22:04] Dr. Nzinga Harrison: So, as usual, that was a super long answer, but I hope it was helpful. If I had to boil it down to the high points, number one, get support in place for yourself. Number two, get your own evaluation and have your wife do her own evaluation so we can see if there’s anything underlying there that we need to be supporting the two of you on. Number three, widen the concept of the magic formula and really have your son say these are the pieces that I think are helping keep my substance use disorder into remission, and start there.
[27:10] Claire Jones: If a parent is accessing some of these resources, like Alanon or of the other ones, and the advice and support that they’re getting is framing addiction as a series of choices that their person can make, then that advice is you need to help them make better choices. You need to give them consequences for their actions. And then those parents, or those people who have a person in addiction, they’re trying to act on that support system. But it’s leading to a divide with their loved one. So how do you then access these resources when sometimes they may be counterintuitive to what you’re saying here?
[27:38] Dr. Nzinga Harrison: It is so very difficult because so much of the guidance out there is actually punitive and drop the hammer. And so the path that we kind of have to navigate, one, keep coming back to In Recovery, because every show we’re going to be talking about how to compassionately walk these boundaries, because you do have to have boundaries. And we’ll get into this a little bit later in the show about keeping yourself safe. So when people hear me say that, I think about keeping yourself physically safe. But I’m also talking about keeping yourself emotionally safe. And I will talk about this the exact same way with cancer and diabetes and Alzheimer’s as I talk about it with addiction. There’s at some point where those illnesses are taking so much that it is creating an unsafe emotional space for loved ones in the support system. And so when talking about that for addiction — this is why I need you to have your own support in place also so you can recognize when you’re getting outside the bounds of that safe emotional space. But have in the back of your mind, is this compassionate? Because you may have to set the boundary that says, for my emotional safety and for my physical safety, you cannot live in this house. You may have to set that boundary, but there’s a way to set that boundary that says, “I’m tired of you choosing these drugs! Get out!” That’s not understanding that they’re not choosing the drugs, they have chronic medical illness, which is these are the symptoms, and the symptoms are painful. But that’s not sending the message that I can see you separately from this illness. And I love you. And I want you to do the best. And you can always call me. But for safety, I can’t have you in the house. So let me figure out how I can support you even without you being in the house.
[29:45] Dr. Nzinga Harrison: You see how it’s the same message. It’s the same boundary that I set. But it’s similar to the way, like I say, when I’m trying to talk to my sons who are 13 and 14, and they’ve done something that I’m like, that was a bad decision. I’m really disappointed in that. This behavior and this choice is awful. That it’s different from “my child is awful.” And so I want parents and support system to, even as you’re getting support from somewhere else that might be saying you need to keep that kid out of the house, it may be that the right boundary to set is that you cannot live with me anymore. The way you carry that message — I want you to separate out and say, like, OK, my anger and heartache is at the substance use disorder. My love and my compassion and wanting this person to get well is pointed at my child. And so how do I set this boundary in a way that they know I love you? I am doing this because I have to keep myself safe so that I can be here to support you when the time comes. And that my hate and my anger and my rage is directed at the illness that I see killing you, as opposed to directed at you.
[31:10] Claire Jones: Our next question comes from a mom of a 23 year old who has been battling alcohol addiction for a long time. She’s tried a lot of different treatment models and it doesn’t really seem to work. She started drinking when she was 15 or 16, and that was the first time that they put her in treatment. So let’s play a little bit of her voice mail and see what she says.
[31:33] Caller: Hi, Dr. Harrison. I feel like we’re in this cycle of treatment where she will do residential but falter after she leaves residential. And she is in a sober living environment, doing intensive outpatient or even partial hospitalization. It never seems to last. And at this point, you know, my family wavers on this, but we feel that more treatment, specifically residential, is not really what she needs, because she has not made a commitment towards sobriety and she admittedly has said that to us. So we’re kind of in that point where what does a family do? What can we do to support her? How does an alcoholic break the cycle of treatment and recidivism? Any advice would be appreciated.
[32:34] Dr. Nzinga Harrison: OK, Mom, thank you so much for leaving us this voicemail. I can hear what you’re going through in your voice. And so tell me if I get this wrong, but what I feel like I hear your voice is a little bit of feeling at the end of your rope, but not wanting to give up. And so I want to say I totally, totally, totally understand that emotional place. I want to start just a little bit with the phases of the illness of addiction. And so the active phase, which it sounds like your daughter is in, is the phase where you’re using, but also all of the other symptoms that come along with it. So maybe trying to cut back, or not trying to cut back, stress on the family unit, interfering with fulfilling life roles, which for a 16 year old is like high school and socializing and friends, all of the other pain and difficulty that comes out of having an active addiction. And then there’s remission. And so we actually define remission in two different phases: early remission, which is within one year. And that literally means you do not meet more than one of the diagnostic criteria for addiction. So it’s not just using, it’s all those other symptoms have to disappear for a person to be considered to be in remission. And then sustained remission is after the illness has been in remission for a whole year. Because remember, guys, what we’re driving home in all of our brains is that it is the illness that relapses and remits, not the person. So once the illness has been in remission for a year, that’s sustained. The reason we draw that line is because of the risk of the illness relapsing falls substantially after we’ve been able to get that illness in remission for a year.
[34:37] Dr. Nzinga Harrison: The other thing that’s very important is that active use is actually for three months before you can get in early remission. So until you’ve not met any diagnostic criteria for three months, we don’t call that illness in remission. And the reason that’s important is because a 30-day treatment and we feel like we fixed it, we’re not even out of the active phase of addiction. A three-month residential stay, we just dipped our toe into early remission. And the reason that’s important is because in active phase, a lot of interventions are needed. In early remission, a different set of interventions are needed, but still a lot. In sustained remission, a lower set of interventions are needed, but still interventions and prevention. And so it sounds like we may not have even had a period of early remission for your daughter yet. And the reason I’m saying that is because when we’re at this point in the cycle — and your daughter has clearly said, I’m not trying to be completely abstinent — then that puts us in a posture that is called harm reduction. So if we think about the treatment of chronic medical illnesses, there is, for substance use disorder, complete abstinence, which is like we want this illness completely in remission. Zero diagnostic criteria, not using any other substance ever at all, period. That is the black and white stance on treating substance use disorder. For many people like your daughter, it’s not what they want, and even for some people who would love to be completely 100 percent abstinence, the severity of their illness does not allow that. And so the position we take to still be able to support our people who either or are not setting a goal for complete abstinence or even with that goal, have a hard time getting to that goal just by virtue of the severity of their illness, is harm reduction. And there’s this really beautiful quote — the Harm Reduction Coalition actually is a national organization that seeks to reduce the harm for people who are actively using drugs. And there’s this really beautiful quote by their executive director, her name is Monique Tula. And I heard her say it live. And I was like, oh, rainbows just burst forth from my heart. And she said, “the practice of harm reduction is the practice of unconditional love for people who use drugs.” And I feel like that’s what your voicemail is trying to break. It’s like I’m trying to figure out any and everything I can do to practice unconditional love for my daughter, even though she has said I’m not making a commitment to sobriety. And so what I want to do is reinforce you. High five, you big bear hug you.
[37:45] Dr. Nzinga Harrison: Like if I saw you in person right now, we could probably cry over this together because this is what your daughter needs. She needs the warm embrace of unconditional love, of harm reduction. And so if you can change your stance just a little bit for your daughter, and say, OK, if you’re not making the commitment to complete abstinence and sobriety, what can we make the commitment to? Because I don’t want you to die. I don’t want you to get liver damage. I don’t want you to be in an unsafe situation where you’re intoxicated and get assaulted. So how do we reduce the potential harm of your use, even if you’re not making the goal right now for complete abstinence? And so I agree with you, if she does not want complete abstinence, there is probably not a residential program that is going to respect her autonomy to make that decision. Sometimes there are mental health clinics — they actually can be pretty hard to find because this country is pretty abstinence-oriented, because that is what the idea of “successful” treatment of addiction has been in this country. And that’s part of what we’re trying to do with In Recovery, is to let moms and dads and loved ones know that you can still have unconditional love for your child. Even if they don’t commit to complete abstinence, there are still things that we can do to try to reduce that harm. And so then just rolling into, like, OK, you were like. So that was a great speech. But what can I do? So specifically, just like I told Dad, get support in place for yourself. The point of this is to keep enough emotional bandwidth for yourself to be able to be on this journey with your daughter.
[39:45] Dr. Nzinga Harrison: This is literally what your individual therapist’s responsibility to you is. That is so that you can go in that space and you can say whatever you need to say without worrying about the emotions of your daughter, without worrying about is it going to hurt her feelings? Without worrying about are you going to be judged for being a mother that doesn’t have compassion? You need to be able to go in your therapist and say, I mean, “if I cut her head off, I would cut her head off!” Now, we don’t want to cut her head off, but we want you to have a space where you can go to your therapist and say, “I swear I’m going to cut her head off!” And then your therapist can help you unpack that emotion. What is the baggage that’s bringing that emotion? And so when you finish your individual session, you take that to your daughter. And instead of “I swear, I’m going to cut your head off,” it is “the amount of pain I have as your mother, seeing you go through this right now is so immense, I feel paralyzed by it.” That’s what individual therapy does for you, because if you say I’m going to cut your head off, that conversation is straight down the toilet. Nothing good is coming of it. But what we have to know is that addiction takes us to that fury and that level of emotion where you feel like all I can do is scream and choke you. Like in that moment, I feel like that is all I can do. But individual therapy helps me to know that’s not helpful. And so you go, you do your session, you come back and you say, “I know it feels like we’ve been at this point before, but we haven’t actually been at this point. There are some things that are similar. It feels like we’ve had the same conversation. But that was yesterday and this is today. And even though it’s hard for me to let go of yesterday, I’m trying to be in this moment, so I can figure out how I can be helpful to you.” And your own individual support creates that space and gives you the tools to be able to have that conversation. You need a space where you can have those raw emotions because otherwise they just stay in you and poison you.
[42:22] Dr. Nzinga Harrison: I don’t want you to have any guilt over any emotion that you have. This is painful and awful, and it steals everything. It steals everything. And that’s why you can’t go through it by yourself. Because that’s my responsibility as your professional support person is that when you’re empty and you don’t have access to your own hope, I hold that hope for you. When you only could access your rage and you can’t reach your compassion, I hold that compassion for you, and I light the pathway for you to get back to that hope for you to get back to that compassion by letting you dump that rage and hurt on me instead of all of your loved one.
[45:01] Dr. Nzinga Harrison: So, Claire, let’s do a role play and practice so our listeners can hear how this might actually go into real life. I’ll be a mom who just came for my individual therapy session, who’s going to talk to my daughter who’s still drinking. So, Claire, I know we’ve talked about this before, but I see your drinking seems like it is increasing, and I’m really worried about you. And I’m wondering if it’s time for treatment again.
[45:31] Claire Jones: I don’t want to go to treatment. I’m not ready to do that. I don’t anticipate wanting to stop drinking right now.
[45:39] Dr. Nzinga Harrison: So let me separate the two of those: not wanting to stop drinking and not wanting to go to treatment, or are they like the same for you? Like, are there reasons you don’t want to stop drinking that are different for why you don’t want to go to treatment or is all wrapped up?
[45:56] Claire Jones: Well, I just feel like if I go to treatment, then I have to stop drinking, and that’s not really what I want to do.
[46:03] Dr. Nzinga Harrison: Is there anything about your drinking that you want to change?
[46:07] Claire Jones: I’d want to have a little more control over how much I’m drinking and how often I’m drinking, but I don’t want to have to be sober. I want to still be able to go out with my friends and have a drink. I want to still be able to come back from work and have a drink. So maybe just the amount and the frequency.
[46:31] Dr. Nzinga Harrison: Yeah. No, I totally get that. I totally get that. I thought you were gonna say for me stop stressing you out about your drinking.
[46:41] Claire Jones: Well, obviously, that too, mom.
[46:45] Dr. Nzinga Harrison: I mean, you know it’s my job to let you know when I see something that’s worrying me, but I don’t want it to be my job to stress you out. So what I really want — and this might shock you — is just for us to be on the same side of this thing. Like I feel like alcohol is between us, and I don’t want alcohol to be between us. I want it to be me and you, and alcohol over there. So I guess what I’m changing about the way we’ve had this conversation before, and even the way I opened this one up, which was like basically when are you going to stop drinking? Is can we figure out if it’s that you want to drink without it being dangerous, can we be on the same side of figuring that out? Which just means you have to be able to tell me what you’re doing and I have to be able to take it.
[47:39] Claire Jones: Yeah, I mean, that’s what I was gonna say. I think as long as you’re not going to make me feel guilty about it, and as long as you’re not going to keep harping on when I’m going to stop then, yeah, I think we probably can’t be on the same side about it.
[47:52] Dr. Nzinga Harrison: So what I can promise is that I will try. But this is new, this is new to me. And so what I can say is that there is nothing to me more important than you, and I’m not going to let alcohol take our relationship. And so it’s going to be hard for me, but I’m going to try. And so much I’m going to try that I went and got my own individual therapist so that I can get better and better and better at keeping alcohol from in-between the two of us.
[48:25] Claire Jones: I will say this is the first time we’ve had this conversation without you telling me that you want to cut my head off, so.
[48:33] Dr. Nzinga Harrison: I want to cut alcohol’s head off and sometimes I mix that up with you. But please, know, even if I want to cut your head off, I would never do it.
[48:48] Dr. Nzinga Harrison: And so kind of like do a debrief on that role-play. Mom let herself get a very vulnerable position. Mom let daughter be in the autonomous role. Mom explicitly separated the alcoholism from the daughter, and pointed anger there. And it was like above all else, no matter what happens, I’m committed to making sure our relationship makes it through this. So the thread that I try to put there was kind of like that unconditional compassion. I’m putting myself in a place of vulnerability. This is so important that I’m getting my self help. How do we make it me and you against alcohol instead of me against you and alcohol.
[49:49] Claire Jones: Yeah. I mean, even though that was role playing, I feel like you’re being vulnerable. So now I can be honest about this again. I think the language that you have made it easy to be like, OK, like let’s have a conversation about this.
[50:04] Dr. Nzinga Harrison: I will say it is much easier to do in a role-play than it is to do in real life, because your emotions — I’m talking to mom and dad and everybody else listening — your emotions are going to be on 50 on a scale of 10 when you go into that conversation. And so literally, it’s like deep breathing, lavender essential oil, cup of hot tea, like try to go into it the calmest you can. The signs that you’re going to get that you’re walking towards that edge are going to be your heart beating, the lump in your throat, your stomach churning. And so feel free — if you feel yourself getting to that point in that conversation where you can’t hold on to your new position of unconditional compassion, because that takes a lot. A lot. A lot. A lot. A lot of practice. You’re going to have to keep trying and keep trying and keep trying and keep trying. Then you can for sure say to your loved one, like, I feel my emotions getting really high and I don’t want to break this moment that we’re having. So, like, I’m going to take a space for myself because I feel like this is the most connected we’ve been able to be on this. And I don’t want to break this. So I’m just gonna take it, but know that everything I just said, I meant it. I’m going to go get myself some support and I’m gonna come back and I’m going to try again.
[51:30] Claire Jones: And I think that actually that is a really good example of the way that these conversations can go well and be just verbally successful. But I think one thing that we haven’t really talked about was the more extreme situations, because those are a big part of this. So I actually want to read an email we got from a listener who says, “how do we support the family and loved ones of an addicted person whose behaviors are causing harm? For example, the mother whose son is experiencing addiction, held her at knifepoint until she barricaded herself in her bathroom and escaped out the window. We hear so much of how the best chance a person facing addiction has for recovery is to have strong connections of support and nurturing. How do we help families and friends draw clear and healthy boundaries without guilt or a sense of failure? And then the second question is, at what point does nurturing become enabling?”
[52:21] Dr. Nzinga Harrison: Yeah. So these are like so spot in the middle of what families are dealing with. So thank you for sending in this email. Let’s start with safety. The example, Claire, that you gave, the mother whose son held her at knifepoint until she barricaded herself in the bathroom and escaped out the window, really points to physical safety, but also emotional safety. And so I certainly want to lift up that we have to be aware of emotional safety even when it’s not paired with lack of physical safety. Both are equally important. And so my standpoint on this is that you have to keep yourself safe. Period. Period.
[53:08] Dr. Nzinga Harrison: You have to keep yourself safe. And the definition of safe, both emotionally and physically, will vary depending on what your life experiences have been, what your life circumstances have been. And so there may be a situation where one person can tolerate it. There may be another situation where it’s the exact same situation and another person cannot tolerate that because of what their life experiences have been, it depends on a lot of things. And so what I want everybody listening — I try to get everybody in therapy. Because part of what is so important about therapy is that it actually helps you to know what are your individual safe boundaries, both emotionally and physically. And so because my standpoint is that your safety comes first, period — and I would say this exact same thing about any other illness — the point at which you recognize your safety being threatened is where you have to set your boundary. And we can set boundaries compassionately, for sure. But like this son who held mom at knifepoint until she barricaded herself in the bathroom and escaped out the window, you can get a temporary restraining order or, you know, an ongoing restraining order — I’m not a law expert — but put safety in place for yourself so that your son cannot come back to your house.
[54:49] Dr. Nzinga Harrison: You may be able to talk to your son on the phone and say, “I recognize that this is a symptom of the illness that you have. I recognize that this is the substance use disorder that’s leading to this behavior and not that this is you as a person. Nonetheless, I have to keep myself safe. So know that I love you and know that I recognize this is the illness and also know that I cannot let this illness kill me through you. Set the boundaries, safety first, period. What I also want to give is permission and encouragement for you to set that boundary even when it’s “only” emotional safety that’s at risk, because anybody would look at that and say, oh, man, you need to draw a boundary because her physical safety was at risk. Our emotional safety is just as important. And that bar is in a different place for everybody. If you feel that your emotional safety at risk, draw your boundary. Draw your boundary compassionately. Here are the words: “I know that this is symptoms of a substance use disorder. I know that the substance use disorder is not who you are as a person. Still, these symptoms are putting my emotional safety at risk, and I have to protect myself or I can’t be there to help you navigate this journey. And so here is the boundary I’m putting in place. This boundary is not because I don’t love you. This boundary is because I do love you. This boundary is not because I think you’re a horrible person. This is because I know you have a horrible disease that is putting us at risk.” And set your boundary, set your boundaries. That is a around emotional safety that is around physical safety. It’s a little bit that emotional safety question bleeds into your last question, which is at what point does nurturing become enabling? The definition of enabling is removing negative consequences. And the way I want you to remember that is because the reason human beings change any behavior is because of negative consequences. And so the word “enabling” is like you’re in labeling the behavior to continue by removing negative consequences. Enabling has gotten laden with so much negativity. Like, “don’t be an enabler!”
[57:38] Dr. Nzinga Harrison: And so what I want to separate out is exactly the way this question was asked, which is the nurturing and compassion. And that same stance we took with our earlier mom’s daughter, which is harm reduction and enabling. And so what I want you to think about enabling — as humans, we have our basic needs, like, if you’ve heard of Maslow’s hierarchy, it’s this triangle. And on the base of the triangle, it says like whatever else is on those other levels doesn’t matter if you don’t have your basic needs met. Your basic needs are a sense of security, stability, food, somewhere to live. Those are the basic needs. And so what I want is for us not to consider a person having access to their basic needs as enabling, because what we know is that without access to your basic needs, we can’t address the rest of your health. Now, does that mean that person has to live with you? No. Their basic needs don’t have to be met by living in your house. But when I set that boundary for my safety, you can’t live in my house, but let me help to see if there are resources I can find that can help us, that can help you get that basic need met. I don’t want you in the street dying without your basic needs met, I’m just drawing the boundary that you can’t live in my house. So when we’re talking about enabling, which is removing negative consequences, I don’t want the negative consequences to be those basic needs. Now, above those basic needs, this is like you stole something so that you could have money to buy drugs.
[59:23] Dr. Nzinga Harrison: And I call the police department and I say, don’t bring charges against my son because I’m so-and-so. And by removing that negative consequence, you enable that behavior to happen again in the future. Because what his brain says is, “oh, I stole, and there were no consequences. So I will steal again.”
[59:47] Claire Jones: I have one quick follow up question to that exact example, which is when is the right time to call the police? Because I think a lot of people are reluctant to call the police because it can escalate a situation. And just when is it the right time to call the police?
[01:03] Dr. Nzinga Harrison: Man, it is a really hard question. It’s so hard. The easy answer is when your physical safety is at risk, you call the police. The bigger answer is we should have a line that you can call that’s not the police. But since that’s not available to us, if your physical safety is at risk, call the police. Now, the way we try to mitigate the danger of the police coming is you always say on that 911 call, “my person that I’m calling for has a mental illness.” OK, not a drug addiction, as much as we wish we could say drug addiction, there is so much stigma and violence against people with drug addiction that is not going to develop the compassionate response that we’re looking for. And drug addictions are mental illnesses, so you are being on the up and up with this. So “the person I’m calling about has a mental illness, do you have a CIT trained officer?” So CIT is crisis intervention training. I used to teach CIT for the Atlanta Police Department, one of the favorite things that I used to do. Basically police officers go through 40 hours of training on mental illness and addiction and how to de-escalate situations that involve people that have addiction or other mental illness. And so CIT trained officers, the evidence shows, are less likely to escalate force. There’s less likely to be a deadly outcome, more likely to help get that person connected to treatment, than to just have them arrested with just legal charges and no treatment attached. Everywhere does not have the CIT trained officers. But ask for it, because if they do, they will send one out for you, and that kind of reduces the risk in making that call. So, number one, a person has a mental illness. Number two, do you have a CIT trained officer. And if your area doesn’t, then there is a piece of advocacy you can do as a support system, to try to get your officers to have the training.
[01:02:30] Claire Jones: I think that’s probably a wrap for this episode.
[01:02:33] Dr. Nzinga Harrison: Thank you to mom and dad and emailer who sent us your questions. And we literally can’t do it without you, and don’t want to do it without you. The whole purpose is for people to be able to hear themselves in every episode so they know they’re not on an island. And so that hopefully we can point people to resources so that we can navigate the devastating parts of an addiction, and “wallow” is not the right word because that still sounds sad, but rejoice in the hopeful period of forgiveness and recovery. So with that, we’re going to be doing a future episode on guilt and also on love and addiction. So if you have any questions or experiences, we would love to hear your voice. Send us a voicemail at 833-4LEMONADA. You can also tweet at me @NaHarrisonMD and make sure you tag Lemonada Media. Thanks.
[01:03:42] Dr. Nzinga Harrison: In Recovery is a Lemonada Media original. The show is produced by Claire Jones and edited by Ivan Kuraev. Music is by Dan Molad. Jessica Cordova Kramer and Stephanie Wittels Wachs are our executive producers. Rate and review us and say nice things. And follow us @LemonadaMedia across all social platforms, or find me on Twitter @naharrisonmd. If you’ve learned from us, share the show with your others. Let’s help de-stigmatize addiction together.