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Stages of Change: Forcing A Family Member Into Treatment

There is a debate going on—it’s actually not a new one—about whether or not family members should have the power to force their addicted spouses, children, or parents into alcohol or substance abuse treatment. Those who favor mandated addiction treatment believe that requiring someone to confront his addiction or abuse will put him on the road to recovery. Others express concerns that such mandates violate civil rights.

Maia Szalavitz addressed the issue in Time.com’s Healthland article of October 3, 2012, entitled “Should States Let Families Force Addicts Into Rehab?” (http://healthland.time.com/2012/10/03/should-states-let-families-force-adults-into-rehab/?utm_source=Join+Together+Daily&utm_campaign=63d65f8447-JTDN_Govt_Prgm_Help_Drs_Fight_Rx_Abuse10_4_12&utm_medium=email) Besides her concern for protecting a person’s rights, she also questions whether addiction counselors are adequately trained. She believes that forced rehabilitation cannot succeed unless the addict is humiliated into acceptance of forced changes—and how permanent will changes be if they are forced, she asks.

Half of the addicts going into treatment, Svalavatz purports, are sent there by the legal system; and she believes that such forced treatment is neither effective nor pretty.   Better, she suggests, to offer a market-based treatment model: One in which the addict recognizes the benefits he will accrue from going into treatment. She suggests that programs should work with the addict’s needs in order to attract customers.

However, most addicts will never agree to treatment until they’re backed into a legal or socioeconomic corner.

The Temper Tantrum

You’re probably reading this because you know someone who needs treatment; take a minute to think about the last time you tried to curtail that person’s use of his substance of choice. Did he rant and rave at you, tell you he hated you, and demand that you mind your own business?

If you’re a parent, think about the time when your child was young and he threw a temper tantrum at a store because he wanted some toy that you told him he couldn’t have. He threw himself on the floor and hollered. He was small enough so that you could pick him up and cart him away.

The behavior of addicts when confronted by their family members is very similar. In fact, it really is a full-blown temper tantrum, designed to deter you from ever again insisting on such an outrageous idea as substance abuse treatment. That is why it becomes important for families to persist in their insistence. Addicts will not stop until they are forced to do so, whether the force comes through the legal system or through the boundaries that you draw for the addict.

The Medical Diagnosis of Addiction

Szalavitz makes a good point that for addicts “the fun is long gone.” However, for people who abuse substances, their motivation goes beyond the question of having fun. Medical studies actually suggest that they are more biochemically susceptible than others to activation of the cerebral cortex when they use, which activates a pleasure response. Thus the more they use, the more they want to use. It really is a biomedical condition that they cannot resist. And in the face of this irresistible compulsion comes a need for someone to step in and say “It’s over.”

The Stages of Change

Getting someone into substance abuse treatment means recognizing the need for change.  Addiction counselors talk about stages of change identified as precontemplation, contemplation, preparation, action, and maintenance and relapse prevention. A person in the precontemplation stage if forced into treatment will say, “I don’t know why I’m here. I know people who do things much worse than I do.” If someone is at the next stage, he might say, “Yeah, I know someday I have to quit, but not yet.” The point is to move the person via his treatment plan through the various stages until he accepts the need to maintain sobriety and prevent relapse.

In the meantime, what are your options if you want to force a family member into change? According to Mental Illness Policy.org’s list of State-by-State Standards for Involuntary Commitment, only a few  states specifically spell out legal standards for involuntary commitment in cases of substance abuse: Hawaii, Kansas, Louisiana, Massachusetts, Nevada, West Virginia, North Dakota, Oklahoma, and Wisconsin.  Since that list was published, Ohio has passed legislation and Pennsylvania is working on it, while California has backed off from the issue.  Yet all states in some language or another specify consideration for inpatient care based on mental health illnesses.

What about Szalavitz’s suggestion for market-based treatment options? The fact is that many residential substance abuse treatment centers now offer client-based services that put the addict in control of his own treatment progress. This is called a client-centered approach. The addict helps to determine the treatment goals and hoped-for outcomes. He remains motivated throughout his treatment period to progress toward recovery. That’s why it’s important to choose a treatment center with counselors who have significant experience in addiction treatment.

Always remember as you move toward helping your relative that recovery is not easy.  It’s true that many experts report on a low success rate at drug treatment centers; but the fact is that anybody who goes through a treatment program is learning the tools he needs to maintain recovery, even if this is actually a gradual accumulation of the knowledge and understanding required to succeed.

Just as Szavalatz talks of J. in her story, a young man who became addicted to pain killers through no fault of his own and refused treatment, there are other stories of other people who learned something from repeated exposure to treatment.   There’s another man whose story has not been made public, but he tells of completing a 90-day treatment center and maintaining sobriety for another 90 days and then relapsing to a point of use worse than anything he’d ever experienced.  He awoke one day in a hospital “with tubes coming out of everywhere,” at the brink of death. As he lay in his hospital bed, he began to think of what he had learned during residential substance abuse treatment, and gradually he began to put it to work for himself.  His story hasn’t ended, yet, because recovery is forever; but  that’s where he is right now.

So, should a person be forced into treatment? The law will take care of that if he is charged with driving while intoxicated, or if he hits and kills someone with his vehicle. But what about other endangerments he creates? He may endanger himself by getting so high that he falls down flat on the sidewalk and bashes out his teeth.  He may put himself at risk if he passes out and simply quits breathing. He may endanger his family by getting fired and not being able to pay the bills. He may hurt his family if his behavior while intoxicated brings emotional damage to the people he loves.

Are you ready to hold him—or her—accountable? Maybe it’s time to draw some boundaries. If you or someone you love is looking for to start on the path to recovery call Vista Taos Renewal Center today at 1.800.245.8267.

Additional Resources:

Manderscheid, Ronald W et al. Preventing Chronic Disease, Volume 7, No. 1, A19, January 2010. Evolving Definitions of Mental Illness and Wellness. http://www.cdc.gov/pcd/issues/2010/Jan/pdf/09_0124.pdf.

Visit the government’s Substance Abuse and Mental Health Services (SAMSHA) website and explore counseling requirements for your state, and its National Review of State Alcohol and Drug Treatment Programs, including state by state licensure and certification requirements, at http://www.socialworkers.org/credentials/specialty/c-catodsw.asp.

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