Some of the people in my group had had such traumatic lives starting in early childhood that I wondered they were not on harder drugs. ( Well, I guess it depends on how you rate these things. One guy who had quit heroin said that was a "cakewalk" compared to keeping off cigarettes).
Almost all my friends who served in Vietnam smoked pot when they were there. None of them had any problems with THAT when they got home, but the alcohol was a real problem for all of them. Snotty liberals in those days treated PTSD from Vietnam as if it were God's punishment for participating in an immoral war. And let's forget about Jane Fonda, who may have been a great actress but was and always will be a spoiled narcissistic Hollywood brat ( Sorry, I don't know how I got off on that. I do not stress my own politics in this blog, which most people would classify as "liberal" but I consider myself an independent).
When
their son had to take a medical leave from college, Jack and Wendy knew
they — and he — needed help with his binge drinking. Their son’s
psychiatrist, along with a few friends, suggested Alcoholics Anonymous.
He had a disease, and in order to stay alive, he’d have to attend A.A.
meetings and abstain from alcohol for the rest of his life, they said.
But
the couple, a Manhattan reporter and editor who asked to be identified
only by their first names to protect their son’s privacy, resisted that
approach. Instead, they turned to a group of psychologists who
specialize in treating substance use and other compulsive behaviors at
the Center for Motivation and Change.
The
center, known as the C.M.C., operates out of two floors of a
19th-century building on 30th Street and Fifth Avenue. It is part of a
growing wing of addiction treatment that rejects the A.A. model of
strict abstinence as the sole form of recovery for alcohol and drug
users.
Instead,
it uses a suite of techniques that provide a hands-on, practical
approach to solving emotional and behavioral problems, rather than
having abusers forever swear off the substance — a particularly
difficult step for young people to take.
And
unlike programs like Al-Anon, A.A.’s offshoot for family members, the
C.M.C.’s approach does not advocate interventions or disengaging from
someone who is drinking or using drugs. “The traditional language often
sets parents up to feel they have to make extreme choices: Either force
them into rehab or detach until they hit rock bottom,” said Carrie
Wilkens, a psychologist who helped found the C.M.C. 10 years ago.
“Science tells us those formulas don’t work very well.”
When
parents issue edicts, demanding an immediate end to all substance use,
it often lodges the family in a harmful cycle, said Nicole Kosanke, a
psychologist at the C.M.C. Tough love might look like an appropriate
response, she said, but it often backfires by further damaging the
frayed connections to the people to whom the child is closest.
The
center’s approach includes motivational interviewing, a goal-oriented
form of counseling; cognitive behavioral therapy, a short-term form of
psychotherapy; and harm reduction, which seeks to limit the negative
consequences of substance abuse. The psychologists also support the use of anti-craving medications like naltrexone, which block the brain’s ability to release endorphins and the high of using the substance.
A 2002 study conducted by researchers at the University of New Mexico and published in the journal Addiction
showed that motivational interviewing, cognitive behavioral therapy and
naltrexone, which are often used together, are far more effective in
stopping or reducing drug and alcohol use
than the faith-and-abstinence-based model of A.A. and other “TSF” — for
12-step facilitation — programs. Results of an updated study have not
yet been released.
Researchers elsewhere have come up with similar findings. In 2006, the Cochrane Library, a health care research group, reviewed four decades of global alcohol treatment studies and concluded, “No experimental studies unequivocally demonstrated the effectiveness of AA or TSF approaches for reducing alcohol dependence or problems.” Despite that research, A.A.’s 12-step model is by far the dominant approach to addiction in America.
Jack
and Wendy’s son, who is in his early 20s, began drinking to alleviate
crippling anxiety and ease persistent depression. His drinking, while
worrisome, was not an entrenched pattern, his parents believed. Some of
Jack’s friends suggested that if their son did not attend A.A. of his
own volition, the only thing Jack and Wendy could do was attend Al-Anon.
“The
implication was that there was no other solution,” Jack said. “There
was a great deal of sadness on their part, empathetic sadness, which in
some ways was frightening in itself.”
“A
lot of people credit A.A. with saving their lives,” he added. “It’s
understandable that they can’t dissociate themselves from a program that
worked for them. But it’s an all-or-nothing commitment for life. That
really freaked me out.”
In
A.A.’s literature, “alcoholism” is defined as “a progressive illness
that can never be cured.” Members describe themselves as being “in
recovery,” which translates to lifelong abstinence and adherence to the
12 steps mapped out in the Big Book, published four years after the
organization was founded in 1935. First among them is the obligation for
members to admit their “powerlessness” over alcohol. It also relies
heavily on faith; God is mentioned in five of the 12 steps.
On
a warm evening last month, about a dozen parents gathered to hear Dr.
Kosanke describe the center’s program for families, which goes by the
acronym Craft, for Community Reinforcement and Family Training. It
rejects, she said, the use of three words: “addict,” “alcoholic” and
“enabling,” a term often used to describe the acts of loved ones that
help perpetuate unhealthy behaviors.
Instead
of addict or alcoholic, she prefers the terms favored by the Diagnostic
and Statistical Manual of Mental Disorders, Fifth Edition, or the
DSM-V, which says that patients suffer from “alcohol use disorder” or
“substance abuse disorder,” terms that convey a spectrum of severity.
“Substance
use takes on a lot of different shapes and sizes,” Dr. Kosanke said.
“There are real downsides to labeling a child with a lifetime identity,
when that truly may or may not turn out to be the case.”
And
calling caring behavior enabling, she said, has a way of turning even
acts of kindness into something negative. “Our field hasn’t done a good
job of defining it in a narrow way that’s appropriate,” she said. “If
you give your kid money knowing he will go buy pot, that’s enabling. If
you take your kid to soccer practice, you’re encouraging healthy
behavior. That’s not ‘enabling.’ ”
Part
of the Craft approach has parents take care of themselves, too, said
Lorraine McNeill-Popper, who volunteers for the parent hotline at the Partnership for Drug-Free Kids,
a nonprofit group devoted to recovery for young people. “If you are
sleep-deprived and stressed out, how can you think clearly?” she said.
Ms.
McNeill-Popper has her own family history of drug abuse. Her twin
brother died of an overdose, and she adopted his son, who later became a
heavy marijuana user and ended up in rehab. “I tell parents, ‘It’s like
when you’re on an airplane, and they tell you to put the oxygen mask
over yourself first. That way you can help with the others.’ ”
The
center’s approach is controversial in the recovery world. David
Rotenberg, executive vice president of treatment at the nonprofit Caron Treatment Centers,
a large drug and alcohol rehabilitation provider with branches in
several states, cautioned against approaches that do not set abstinence
as a goal.
“The
majority of people who are chemically dependent would love to be able
to drink and drug in a more moderate fashion,” Mr. Rotenberg said. “Most
drug addicts and alcoholics would love to drink just a couple of
drinks, and they try to do so, with poor results.”
The
C.M.C. doctors say treatment for young people needs to be tailored for
them, since teenagers and young adults are neurologically,
psychologically, socially and legally different from adults, and have
different treatment needs.
Dr.
Wilkens founded the center with a fellow psychologist, Jeffrey Foote,
in 2003. The two had worked together in larger hospital-based treatment
centers where they struggled to introduce evidence-based treatments, she
said. When it opened, the C.M.C. was one of the few centers in the
nation that were not tethered to the 12-step model, she said.
“It
was our strong belief that you can work with people at any stage of
change, ranging from ‘I’m not even sure I have a substance problem’ all
the way to ‘I just got out of rehab and want to go to A.A. meetings
every day,’ ” Dr. Wilkens said. “We don’t have a judgment on how you
address your substance use problem. Maybe A.A. is helpful to you and you
find everything you need there. If it’s not, we genuinely believe there
are many strategies for helping to resolve them.”
In fact, a majority of college binge drinkers do not go on to become alcohol dependent, said Stanton Peele,
a Brooklyn psychologist who has studied substance use for decades and
is a longtime critic of the A.A. model. While binge drinking and other
drug use are risky, multiple studies show that most people “mature out”
of such recklessness when they begin to have increased responsibilities.
A
federally financed study of 43,000 randomly selected Americans, called
the National Epidemiologic Survey on Alcohol and Related Conditions, or Nesarc,
found that 75 percent of those who are heavy drinkers eventually regain
control without rehab or A.A., Dr. Peele said. The survey, which was
conducted in the early 2000s and was designed to be representative of
the larger United States population, was aimed at helping researchers
understand high-risk drinking patterns, design better-targeted treatment
programs and monitor recovery. It found that over half of those who
recover managed to cut back instead of abstaining, Dr. Peele said.
“Isn’t
it more encouraging to know that most people are going to outgrow these
habits than to think they’re going to have a disease for the rest their
lives?” Dr. Peele asked. “The data show that the odds are in your
favor.”
Dr. Wilkens is familiar with that pattern. She was a college binge drinker herself and also struggled with bulimia.
Once she left her home state of Kansas for New York City, where she
attended Hunter College, she felt culturally stimulated and
intellectually challenged, she said, and the drinking and disordered
eating disappeared.
“When
you focus on building up the world around you, you find stimulation and
rewards that are very different from using drugs and alcohol. You find
other ways of soothing yourself, and things can get better,” she said.
That
is precisely what L.S. learned five years ago. L.S., a Manhattan lawyer
in his early 30s who asked to be identified only by his initials to
protect his privacy, spent nearly a decade as an episodic binge drinker.
He began drinking as a student at his large Midwestern university,
where he played rugby and where many of his best friends belonged to
fraternities. Alcohol, he said, flowed freely through both subcultures.
L.S. said he thought his drinking — weeks of no drinking followed by
serious binges of a few dozen drinks over several days — would end after
college. Yet the behavior did not fade. The morning after his wedding,
he awoke with a hangover that lasted a day and a half.
His
father, who drinks socially, told him that people either were
alcoholics or were not. But L.S. was unprepared to accept that label and
began researching moderation on his own. He found a New York branch of Moderation Management, or M.M., a secular, peer-led support group that takes a cognitive behavioral approach.
In
contrast to A.A., which stresses a drinker’s lack of power in the
presence of alcohol, M.M. encourages personal responsibility for
drinking. The group, founded in 1993, encourages members to start with
an alcohol-free month, and then allows for the reintroduction of
moderate amounts of alcohol. (Critics note that one of its founders,
Audrey Kishline, was involved in a fatal accident while driving drunk.
She left the group in January 2000 with the intention of joining A.A.,
and three months later, crashed head-on into another vehicle, killing the driver and his 12-year-old daughter.)
L.S.
now attends hourlong meetings once a week at which he and about a dozen
others discuss their goals for moderate drinking, as well as tips,
challenges and progress on avoiding triggers. Since he began attending,
L.S. limits himself to about five drinks a week, well below the 14 drinks M.M. advises as a safe limit for men.
L.S.
is convinced that there is no single approach for all problem drinkers.
“M.M. doesn’t profess to work for everybody. It has a scientifically
based approach that works for some people,” he said.
The
C.M.C. psychologists are blunt about the reasons many teenagers and
young adults use drugs: When it comes to decreasing anxiety and
relieving depression, substances tend to work for the short term. “Kids
aren’t crazy for using them,” Dr. Wilkens said. “They have an effect
that is reinforcing in some way. If you understand that, you can
strategically work to support and reinforce other healthy, competing
behaviors.
That
approach runs through the book she wrote with Dr. Foote and Dr.
Kosanke, “Beyond Addiction: How Science and Kindness Can Help People
Change.” It was published in February, just as the death of Philip
Seymour Hoffman from a heroin overdose
struck fear in the hearts of many parents whose children use drugs. It
landed Dr. Wilkens on several talk shows and drew scores of calls to the
center. (In addition to its New York office, the group has opened a
residential treatment center in the Berkshires.)
Dr.
Wilkens’s message struck a chord with Wendy. Her son had just left
school, and the couple was exploring treatment options. Wired in the
evenings with extreme anxiety, he drank excessively to get himself to
sleep. Once in bed, he’d stay there till 5 p.m.
Before
she read the book, Wendy said, she would stomp upstairs hourly to
announce in an exasperated voice, “It’s 2 o’clock. You’ve got to get out
of there.”
“I’d
do that three or four more times and then be fuming,” she said. “I’d be
fuming all day, at home doing my work and knowing he was upstairs
sleeping off whatever he’d been drinking the night before.”
After
learning the Craft approach, Wendy said, she stopped nagging, changing
her negative, accusatory tone to a more pleasant one by asking
open-ended questions.
Today,
Wendy and Jack’s son is working with his psychiatrist and getting help
for his depression and anxiety. He seems to be bingeing much less. When
the family went out to dinner on a recent night, the parents each
ordered a beer or a glass of wine and sipped slowly through dinner. “How
will he learn moderation if he doesn’t see it modeled?” Wendy asked.
Ellie
hopes her daughter, too, will be able to change her drinking patterns.
Ellie is a New York editor, who asked that her last name be withheld to
protect her family’s privacy. Her daughter, 23, has struggled with binge
drinking since she was 16. While her daughter graduated from college
and holds a responsible job, she still binges on weekends. “It’s so much
a part of the culture, it’s everywhere,” Ellie said. “She says she’d
have no social life if she stopped drinking.”
Ellie,
who grew up in a home in which many relatives attended A.A., at first
tried Al-Anon. “They talk about ‘disengaging,’ ” she said. “But it’s
your child, and I’m not one of those people who can put her out on the
street.”
While
their daughter has resisted treatment so far, Ellie and her husband
have begun seeing a therapist at the C.M.C. to better navigate their
relationship.
“My
child is much more than a label or a diagnosis,” she said. “She’s not a
problem to be solved, but a child to be loved and guided toward a
better life.”
No comments:
Post a Comment
Please leave a comment-- or suggestions, particularly of topics and places you'd like to see covered