Question: I’m a pro DJ with a cocaine problem. Things are getting out of hand and I have decided to get some treatment. The problem is my job and my drug use are pretty linked together. I can’t imagine doing my job without being very tempted to use cocaine but my job is a huge part of my life and I have worked very hard for a long time to get to a place where I can make a good living doing what I love to do. If I go to drug rehab is everyone going to tell me I have to give up my job as a DJ?

Dr. David Sack Says...:

In some ways your situation is similar to anesthesiologists whose work exposes them to drugs that are passively absorbed.  Like DJs they have a very high incidence for drug addiction compared to other people.  Even after an addicted anesthesiologist receives treatment, they can’t return to their previous occupation, even though they can remain in the medical field as another kind of physician. It may be too much to hope that with treatment you can return to being a DJ.  Even if you were to try, any success would depend on a sustained period away from the dance floor first.  How long is hard to say but probably at least a year.  You may want to think of your career more broadly as involving music, and look for a path that may give you more control over your work environment.

Question: We are planning a family intervention for my dad. He started drinking really heavily after he retired and he is going downhill fast and all of us in the family agree that we need to get him some help right away. I am organizing this thing and the family is behind me on all of it. The main problem I have is that I am not sure what kind of treatment he needs to get, providing he agrees to go. I think that alcohol rehab would be best. But he is a kind of cantankerous 62 year old ex general contractor and I cannot imagine him sharing his feelings and fears in some sort of touchy feely group session with a bunch of people half his age. Is this important? Our budget is not huge but there are some general rehab programs around here that we can afford. Programs for older adults that I have looked into tend to be farther away (which I think will be hard to sell to my dad) and more expensive (which is a problem). How important is it that we get him into some sort of treatment with people his own age?

Dr. David Sack Says...:

At age 62, it would probably be better for your dad to go for detox and treatment in a residential setting if that is financially feasible.  The age ranges vary a great deal at different programs and your father would probably have a better experience in a program that predominantly treats people who are middle age or who offer special groups separated by age.  His needs and challenges may be quite different than a 20 something who has dropped out of college because of cocaine and pills.
 
Having said that, treatment is always better than no treatment.  Many programs will offer adjustments or payment plans to help clients get into treatment.  You should not be afraid to ask for an accommodation, since the worst that can happen is that they say they do not have any available.

The good news is that regardless of the program he attends, there are many different AA meetings in the community and he is likely to find a number of them where he feels comfortable with the members.

You might consider using part of your budget for a professional interventionist. Not only will they increase the chances of getting your father into treatment, but they may also have relationships with rehabs that will make negotiating the cost easier.

Question: I'm sure you know what has happened in Florida. ALL Pain Managment drs are shut down. I have no intention to going back. I'm detoxing at home from Roxicodone - 30 mg. Tapered and started taking vitamins specially for this. Now my question, I still have xanax. I want off. I was prescribed Lexapro but it interfered with my Roxis. I know you're not my dr, but do you think in your personal profession it would be okay to start my lexapro again while tapering from xanax? I'm lucky tho, i only started taking xanax 2 months ago, (half a "bar"). Everyone in south florida looks at you like a piece of junk when you go for help. That's how bad it is down here. No one here cares that some of us are actually trying.

Dr. David Sack Says...:

Until recently physicians in Florida prescribed 10 times as much Oxycontin and prescription pain killers than other states.  This was due to lax regulation and supervision.  The inevitable backlash may be making it difficult right now for legitimate pain clients to obtain treatment they need.

Coming off of Xanax can be more difficult than coming off of opiates.  The intensity of withdrawal symptoms from Xanax and similar medications depends not only on the amount they were taking but also on the total amount of time they have been taking them.  Stopping Xanax or similar medicines (benzodiazepines) should only be done under close physician supervision.

Lexapro can be helpful for anxiety and depressive symptoms that often accompany chronic pain but you need a physician who is going to monitor your response to the medications and observe for side effects.

Question: My wife wants us to dip into our savings, not that we have so much of it, to help send her 28 year old crack loving sister to rehab…again...for the third or fourth time she’s gotten into some sort of program. I love my wife and I understand how she loves her sister and if I thought it was going to help take away some of the pain in this family by getting that hopeless case better then I would do it in a heartbeat, but we don’t have so much money that I can afford to throw away good money after bad every time she gets it in her head that she needs a little break from her partying ways. How can I know that there is any chance it’s going to work this time. As far as I can tell, every time this happens its my wife and my mother in law that get together and convince her to get clean and help her with getting into some sort of program…little interventions. It’s never her on her own that says, “OK, I am ready and I going to really do it this time.” Doesn’t she need to hit her own rock bottom before she can decide…on her own…to get better once and for all. And until she does isn’t all this time and money and effort just a huge waste of time? Thank you for your time

Dr. David Sack Says...:

Your wife’s sister may be eligible for county or federally funded drug treatment. Most people don’t realize that more than 80% of drug and alcohol treatment in the US is paid for by government funds. Treatment is provided by licensed or certified residential and outpatient programs and while the facilities will not be glamorous, she would likely get responsible care. There are a few things to know about these programs before getting started. First you have to be financially eligible. This often means little or no income or property. As the budget crises have worsened as a result of the recession, funding for many of these programs has been cut back, and criteria have become more stringent. Second, there is often a waiting list and it can take weeks to months to be admitted. Finally, these programs are typically best suited to individuals whose drug or alcohol problems are not complicated by other psychiatric diagnoses since it many cases they may not have a psychiatrist available to consult with clients.

There is considerable data that shows that many people who do not achieve stable abstinence after one treatment episode are successful later on. There may be several reasons for this. When they enter treatment again they may be at different juncture in their lives and may have suffered more losses from the substance misuse (fired from work, left by spouse, homelessness). Second, the treatment approaches may differ. Someone who did not benefit from Cognitive Behavioral Therapy may do well with Motivational Interviewing instead. People with co-occurring problems such as Post-Traumatic Stress Disorder, Major Depressive Disorder, Bipolar Disorder or anxiety disorders, will have much better outcomes when these other conditions are treated. For example, clients with Major Depression at the end of rehab are 4-12 times more likely to relapse in the next year than those who are not depressed.   Remember that there are many major diseases that require continued treatment - not just one hospitalization, and it is now well accepted that addiction is a disease.

The fact her mother convinces her to go is not unusual - no one wakes up in the morning after a binge and tells themselves that today would be a good day to quit. It is very rare for people to seek treatment on their own without external pressures and there is considerable evidence that when people are coerced into treatment (as in court ordered) they do just as well as those who ostensibly chose treatment for themselves.

In order for your sister-in-law to succeed in treatment, she needs to come to belief that her life would be better (happier, more fulfilling, more meaningful) without drugs than with them. This realization usually comes after someone has been in treatment, not before.

The problem of waiting for someone to ‘hit bottom’ is that you can only know what their bottom was after the fact, and never before. It doesn’t make getting additional treatment a waste of time, but that doesn’t mean that you and your wife should continue to carry the responsibility for her. I am sure both your wife and mother-in-law are desperately afraid that that her sister will die on the streets of an overdose, assault or suicide attempt and these fears are not unfounded. Suicide is the leading cause of death among individuals dependent on drugs or alcohol.

I think it may be time to conserve your resources by looking for less expensive or publicly funded programs and to use your funds to pay for ancillary services that may be needed.

Question: I caught my son with some sort of herbal marijuana, and I’m not sure how worried I should be. He says it not real marijuana, only some sort of herb blend and that it’s not even really illegal or harmful. He says it’s no big deal and that he’s smart enough not to do ‘real’ drugs, and that I’m freaking out for nothing. My son has always been a really nice kid and a good student and involved in bands and sports other activities at school, but this year it seems different and we’re getting pretty concerned. He just turned 17 and he doesn’t seem to care about any of that stuff any more; he’s always hanging out with a new set of friends that I don’t really know and we’ve caught him coming home drunk a few times over the last year or so. We’ve tried grounding him and taking away his keys to the truck and talking about our worries but all we get in return is bad attitude and no change in his bad behaviors. My husband suggested we consider some kind of treatment program to deal with the drug taking before it gets too serious but when we brought this up with Andy he went crazy and said he wasn’t a drug addict and didn’t need any kind of help! Is my husband right? Should we get him into some sort of treatment program?

Dr. David Sack Says...:

From what you report, all indications are that your son has a drug or alcohol problem and it is getting worse.

Changing friends, loss of motivation at school, and shifting moods point to a drug problem.

There is no such thing as herbal marijuana - some of the preparations sold as herbal marijuana were sprayed with a synthetic marijuana-type drug that had most of the same effects as smoking pot. Unfortunately, the synthetic marijuana is not detected with routing drug tests. We strongly agree with your husband that your son should be assessed by a professional who has experience with drug and alcohol abuse and who can inform you about what the next steps should be.