Question: My daughter was in rehab for 28 days for drugs and alcohol. While she was in rehab, she wanted contact with both her family and her in-laws. Now that she is out, she only wants contact with her rehab buddies - none with her in-laws, husband (who is off on military orders), or parents. Has decided that she may want a divorce and for me to stay out of her life. As my only child this is breaking my heart. Both myself and her husband have cut her off financially as she won't communicate with us. I'm in an online support group and I've encouraged her husband to go to meetings on base. She threatened to have her father in law arrested if he stopped by the house again (the house belongs to him and its up for sale). I don't understand what is going through her mind and it is so opposite and extreme to her previous self. I know I didn't cause the addiction, can't cure it, can't change it. But I am open to suggestions... Bless you all..

Iona Health Says...:

The prominent feature that you have described in your recovering daughter is her high need to control people, places, and things. This would be considered fear-based behavior. In recovery, people learn that they cannot control anything beyond their own skin or behavior. Although I am not fully informed with your daughter's substance abuse history, she sounds like she is having a very difficult transition from addiction to recovery. Her current behavior suggests a potential for relapse.

There are all kinds of little steps and hints prior to actually relapsing. Some information on early relapse prevention and common relapse symptoms can be found at: http://www.addictionsandrecovery.org/relapse-prevention.htm. Please note that it is important to recognize that "relapse is a process, not an event." The same can be said about personal recovery.

From your description, it sounds like your daughter is suffering from post-acute withdrawal as she is exhibiting behaviors not previously exhibited. The website http://www.addictionsandrecovery.org/post-acute-withdrawal.htm identifies common traits seen in people undergoing post-acute withdrawal. Most recovering people go through post-acute withdrawal, can have extreme reactions, and show impaired coping/decision making abilities while the brain is normalizing its chemistry. Does this describe your daughter?

Normally, you would be happy that a family member is choosing people in recovery rather than old using friends. However, in many treatment centers, recovering addicts are discouraged from associating with anyone that they meet while in treatment during their initial 6 months of sobriety. This is because of the high risk of relapse among former patients or residents. Your daughter and her new rehab friends do have not had enough "clean time" to really know how to support each other in recovery like a sponsor or old-timers in recovery. Perhaps her former treatment staff could help resolve these difficulties with your daughter, her in-laws, her husband, and her own family.

Most people have the recommendation of staying in some kind of treatment or program for at least 6 months after their last drug usage or entrance into a rehab program. Is your daughter in outpatient treatment or aftercare? Does she go to 12 Step meetings? Does she have a relapse prevention treatment plan? Does she have any kind of relationship with her recent treatment center, staff or doctors? If so, these resources could be very helpful in helping her address any difficulty with post-acute withdrawal.

I understand that watching your daughter behave in a discounting, atypical, and uncooperative manner is painful and stressful for you. However, you have been wise to put your own recovery system in place so you do not enable you daughter or get manipulated by her or her disease.

My suggestion is to “let God and let go.” All attempts to reach out to your daughter have met with harsh disappointment so maybe another plan is needed. Here are some ideas:

1. Allow your daughter time and space to see that you are “for” her and not against her.
2. Go to Al-Anon or Naranon for your own support and recovery.
3. Continue to use your online community for support and encouragement.
4. Recognize that your daughter could be alienating herself which is not good because it could make recovery more difficult.
5. Keep channels open with her daughter and those who still have contact with her. Be patient and allow her to initiate contact with you.
6. Avoid all criticism and choose to make positive, supportive and empathetic remarks to her or about her.
7. Acknowledge your daughter when she does things well instead of when she does things wrong. Is she still sober, for example?
8. Recognize that the ball is in her court and she ultimately decides what happens to her. Don’t accept blame and avoid defensiveness.
9. Share this will your daughter’s husband and family so they will take a more supportive and less confrontational position which would only create more alienation and stress.
10. If you talk with your daughter, it might be helpful to talk to her as a person you recognize has had to made some difficult choices and could be having a difficult time with sudden, intense internal and external changes. Be open to the fact that she may be more frightened or sad than angry.

Recovery is a “one day at a time” process. If you need more than I have suggested, I would ask you to consider consulting with a mental health professional who is experienced with addiction and families. I do recognize that this is not an easy situation for anyone, and there are not always easy answers. I hope this has provided you with some support or assistance.

If I can be of any further assistance, please let me know.

Warmly,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: My brother has hepatitis C, he is HIV positive and he is in a lot of pain from abscesses on his toes and legs from injection injuries. He can barely walk at this point and he is only 36 years old. He will not go to the hospital to get the treatment he needs because if he was laid up getting the IV antibiotics he couldn’t be on the street injecting cocaine. My brother rarely makes contact with me other than to try to scam money out of me and since I have been burned by him so many times already he doesn’t succeed to often in doing that anymore. He did get some money out me this weekend though after he called me up and told me he had had his big toe amputated and asked to meet me for some money so he could get a room for a couple of weeks. I gave it to him. He was obviously in pain and having more trouble than normal getting around. I don’t know if he will really get that room or not but it is a shocking thing to see a person (my dear little brother!) who uses cocaine until he needs to have his toe amputated and then still doesn’t want to stop. This is so tragic and insane. I know I can’t make him stop. I have given up on that. I just wish I could make things a little better for him so he wouldn’t be getting gangrene and wouldn’t be suffering such pain from all his abscesses. I know giving him money won’t help, but is there anything I could provide for him that would make his life a little easier and reduce some of the secondary infections and problems he gets from his IV drug use? Should I buy him needles? How many does a cocaine addict need in a week? I have no idea. What else does he need to be able to use without doing himself so much harm?

Iona Health Says...:

First, I would like to express some empathy for your family, you and your brother. Your brother is suffering from three progressive diseases: HIV, Hepatitis C, and cocaine addiction. It is entirely understandable how confusing and conflicted it can be to deal with an immediate family member who suffers from one of these diseases; more or less three of them. Here is a good resource of cocaine addiction complicated by HIV and Hep-C: http://www.stopcocaineaddiction.com/Cocaine-hiv-aids.htm

It is important to understand that addicts cannot progress or make it on their own without the help of others who often enable them. For example, giving an addict “money” is not giving them money; it is giving them their next hit or high. If you have any hope to help your brother get medical treatment for his addiction, his friends and family must stop enabling him with things he wants or needs so he can hit bottom and ask for sincere help. Every addict must hit bottom to find recovery from addiction. The family can raise the bottom for their addict by not giving him resources, like money, and helping him to see how dependent he is and how much help he needs. Have you given up all hope for your brother’s recovery. There are other people with HIV, Hep C and cocaine addiction who are healing and in recovery. The most discouraging aspect of your brother’s health condition is hepatitis C. However, I do see some hope glimmering about Hep-C treatment. Pamela Anderson, the Hollywood star, is the poster child for Hep-C. For more information, go to these websites and see that it is an manageable disease: starpulse.com, people.com.

I think what you are asking is “what role do I play in my brother’s life, whether long or short?” First, you must decide if you want to help recover/heal or try to help him die in the most comfortable way…according to your brother’s addiction. To buy him needles is another way to enable him. Clean needles won’t change his status with HIV or Hep-C since he has already acquired these diseases. If he did not already have them, it might make some sense to arrange for him to have clean needles. By sharing needles with others, your brother could potentially infect others. If you make things easier for him, he many never make different choices…like doing whatever he needs to…to live. With cocaine addiction, hiv, and Hep-C, there is often accompanying depression. When people are depressed they often feel unmotivated and hopeless. Do you think depression could be what is keeping him stuck in a very destructive lifestyle and poor decision-making? My strongest recommendation for him is to have him obtain a professional evaluation by an addiction professional who knows what someone needs to do who does not know what to do with cocaine addiction, HIV, and Hep-C. The Choose Help website offers free assessment.

In my professional opinion, I think the best treatment option for your brother is residential treatment. Here is a link which discusses this: http://www.drugaddictiontreatment.com/addiction-in-the-news/addiction-news/hepatitis-c-drug-users/

As far as your question about how much cocaine your brother is using, I think the only way you might find out is by asking him how much his cocaine use is costing him daily. Then find out the local cost of cocaine by the gram and you will know. I am unclear how this information would be useful to anyone unless they are financing his use.

Finally, for many addicts to recover, the family often has to go into recovery first. There are support groups for family members of cocaine addicts. To find out how other families deal with the very difficult issues which you are presenting, you may want to attend several support groups until you find one that you like. Some websites which give this valuable information are:

• http://www.cocainehelp.org/mod-subjects-printpage-pageid-4-scope-all.html
• http://www.co-anon.org/
• http://intervention911.com/intervention911_cocaine_info.htm

My hope is that I have provided your brother and you with solid information and some hope for recovery which can be used to stop your brother’s disease process. If you need anything more from me, please do not hesitate to contact me.

All the best,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC