Question: My sister is addicted to pain drugs. This morning her boyfriend found her on the floor not breathing with blue lips (actually she was still breathing but just barely and it looked like she wasn’t). He called 911 and they were able to resuscitate her. This is the 3rd time she has accidentally overdosed. If someone was going to keep trying to jump off a bridge we’d out them in a hospital until they weren’t a danger to themselves, even if they didn’t want to be there. My sister doesn’t want treatment right now but she is going to die soon without it – so what’s the difference? How is one form of suicide different from another? The hospital says they can’t take her on unless she agrees to the treatment. Is there anything I can do to get her forced into this?

Scott Graham Says...:

People can be having a heart attack and refuse treatment.  The same is true for addiction.  We have zero control over other people's choices.

Something that may help is doing a professional intervention.  A licensed alcohol and drug abuse counselor in your area may be able to assist you in setting one up, including coordinating admission to a treatment facility if the intervention is successful.

Question: Is individual therapy in rehab important? I am looking at a place for my brother that is all group therapy and AA and stuff. There’s this other place that also has private counseling sessions but it is a lot more expensive. My mom is footing the bill and I am trying to help her make a smart decision.

Scott Graham Says...:

Group counseling can be very effective independent of individual counseling.

It very much depends on where a person is in terms of taking action in their recovery.  And it also depends on what modality of counseling (Reality Therapy, REBT, Motivational Interviewing) that the counselor says they are practicing.  Reality Therapy and REBT have been shown to be very effective in a group context.  Motivational Interviewing has not been show to be effective in a group context.

For example, if a person is solid in their desire to stay sober and the counselor practices motivational interviewing they would probably be fine -- just needing peer support -- in which case the group functions more like AA.  But if the person is uncertain about sobriety and the counselor practices motivational interviewing, individual counseling would be more effective.

Furthermore, the entire milieu of the treatment center has an impact -- this factor can be the biggest factor of all.  I worked in an adventure-based program for many years and the therapeutic power of the wilderness / group milieu was tremendous.

Question: I have pretty much flunked out of my freshman year at college after spending the first semester playing video games and getting high every day. My parents were very angry when I told them the bad news but now they are mostly concerned I guess. They want me to go away to some sort of wilderness drug rehab adventure challenge program for a few months before I try again at college next year. I can see that I really screwed things up bad this year but my parents are mostly worried about my smoking weed but for me the weed is not really a big deal and I can kind of take it or leave it….even if I did mostly take it for the last few months. My parents are really straight and they can’t really understand that smoking weed isn’t really such a big deal. To them drugs are drugs and weed might as well be heroin. I don’t know what to say. I keep telling them that I don’t really need this whole expensive adventure rehab but they keep pointing out my giant failure at school as evidence that I do and that is kind of hard to argue with. I don’t know how to explain to them that I don’t need rehab? How can I make them see that smoking weed everyday for a few months isn’t the end of the world? The people they are talking to at the rehab are telling them that I really would benefit from coming but I am not sure they are totally unbiased here. I feel like my parents need to hear that I don’t need to go from someone they would listen to, like a doctor or someone, but I am not sure who to turn to and our family doctor is pretty old and I am not sure he’d be the best choice for this. Is there some kind of doctor who is neutral that will evaluate my situation and make some sort of recommendations for what I should do? My parents won’t listen to me but if an expert told them that rehab was crazy I think they would listen to him.

Scott Graham Says...:

This 400-year old saying means: results are what counts.

If smoking pot is really not such a big deal and you can pull it together and keep your grades up then you have proved that smoking put is not such a big deal.

Before launching into some intensive program it is always best to try less intensive strategies first (like outpatient counselor or coaching or some other strategy).  Then if those fail, you would look for something more intensive.  (The only reasons to skip this and go straight into an intensive residential type program is if there are interfering factors that can only be fixed by getting the "hell out of dodge"  -- like you live in a crack house and want to stop using cocaine).

My suggestion is that you first make a deal with your parents:  agree on what your life should be like if you are functioning well (paying the rent, no legal issues, steady job, saving money, healthy body, mostly Bs with a few As, etc).  Put it in writing so everyone is clear.  If you go below X then you agree to go to this residential program.  Sign it and stand behind your word if the results prove you wrong.

You should also make a deal with yourself -- when might you take action if things start sliding?  (And by action I mean getting a counselor or coach or some other strategy -- smoking pot on the weekends only -- I don't know -- some way that if you knew you were going to get Cs and Ds that you could step it up and do something about it instead of waiting for your parents to do it for you -- or to you -- depending upon your perspective),