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December 2010

How Do I Know If My Child Has A Drug Or Alcohol Problem?

The answer isn't the most important thing...

As an addictions specialist, I get lots of calls from worried parents. It’s usually a bad news/good news scenario. The bad news is that most of the parents calling are beyond the point of wanting to know if their child is getting high--they’ve known it for a while by the time they finally pick up the phone to call.

The good news is that even though addiction is a progressive and chronic problem, without a commitment by the addict to maintaining a sober lifestyle, it can be a very treatable problem, especially with early intervention. And that initial call inquiring about a problem is a very important and necessary step in the process of getting help.

I use the word “process” because people come for help for a substance abuse problem with varying levels of motivation and ambivalence. Most people I see initially are being prodded or coerced to attend treatment: by a parent, spouse/partner, friend, doctor, or a lawyer.

Even parents, who are usually feeling terrified and often desperate when they are calling about their troubled teenager or young adult, have some level of ambivalence about seeking help. They’re scared, or guilty, or embarrassed or usually a combination of these or other uncomfortable feelings. They’ve probably put off for a long time making that first call. The process of reaching out for help mirrors the process of addiction recovery itself: it’s not a straight line but a series of steps: two forward, one backward, up and down, ebbing and flowing.

The importance of that initial call by a parent is not based so much on the content of the discussion--the specific information shared--but the fact that the first call represents two crucial factors that need to occur in the early recovery process to increase the likelihood of a successful parental intervention: the willingness to educate yourself about addiction and recovery; and taking steps to reclaim control of your parenthood.


Accurate information is a front-line weapon in the battle against the disease of addiction. Addiction is a complex interaction of biological, psychological and interpersonal (social, family, peer relationships) factors. The more information you arm yourself with--for example, what addiction is, about the specific substances of abuse, types of addictions, the nature and process of addiction and recovery--the better position you’ll be in to figure out the action steps to take to feel more control of your child and his/her problem

Reclaim Control of Your Parenthood

I like to view that first call for help as the first step by a parent to get back in the driver’s seat of the family and reclaim control of parenthood.
An important shift in family functioning occurs when a family member is struggling with addiction. The addict is an expert at deflecting responsibility away from herself. Family members, out of love and concern, will be often willing to accept some (or a lot!) of the responsibility and even blame for the addict’s inability to take care of herself. So in addition to giving parents some specific information during that call, I’ll have them start the process of figuring out how they can begin to focus on which aspects of the problems associated with the addict’s behavior that they can control, or actually do something about. This is the first step in the parent’s own recovery.

Taking steps towards reclaiming your parenthood will begin the process of shifting the family functioning towards a healthier state and reduce the fear and helplessness for parents.

FYI: Elsewhere on PARC, I share some basic screening tools for getting a better sense of the difference between use and abuse:

Stigma Busting

by Barry Lessin

December 9th, 2010

The stigma associated with addiction and mental health problems in our country is very disheartening. It's pervasive, existing at all levels of our culture and society.

As a provider of counseling and treatment services for these problems, it feels to me like an invisible wall or barrier that my clients and I are often trying to climb over to get to the other side. Then there are the people who are not yet in treatment, who experience stigma as an Everest-sized mountain, too high to begin to even think about climbing.

Dr. Harold Koplewicz, one of the nation’s leading child and adolescent psychiatrists and strong advocate for child mental health, recently posted and article on Huffington Post about the divisiveness associated with children's mental health. His writings are a welcome voice of reason and information in the struggle to lower the stigma associated with mental illness and addiction in our culture.

Some of the same extreme reactions to mental health treatment are seen in other areas such as racial/religious/political differences. Differences between "us" and "other" trigger fear in us as human beings. This fear is a natural physiological survival response otherwise known as the "fight/flight" response that we humans share with other mammals.

Accurate information usually reduces fear: when we turn a light on in a dark room after hearing a noise and see that there's nothing in the room to hurt us, we quickly calm down.

We've made some progress in the addiction field in lowering the stigma barriers to make addiction treatment more accessible to those who need it. We have a long way to go with mental illness, and this dialogue can only help.

Read Dr Koplewicz's article here: Why are People so Divided When It Comes to Children's Mental Health?

A great resource about all things related to mental illness, including an extensive grassroots effort to "bust" stigma at its roots, is the National Alliance on Mental Illness (NAMI).

How Do I Know If It's A Problem?

by Barry Lessin

December 8th, 2010

People come for help with a substance abuse problem at varying levels of motivation. However, almost all my clients want to know very early on, usually in the first session, if their use or their family member’s use of a substance is really a problem.

A full evaluation of a potential addiction generally requires a thorough evaluation, but I’ll often use a tool in the first session that will quickly give the person some measuring sticks to help begin to explore their use in more detail. It’s really a quick screening tool, but it almost always opens the door for opportunity to explore their behavior in more detail.

They’re easy to remember, because they all begin with the letter “C”:

1) Control

People without an abuse problem always have control over the amount they drink or use; if they say they're going to have 2 drinks, that's all they ever have.

People with a problem will often go over a self-imposed limit, often with consequences (see #2 below). This is often a "Russian-roulette" pattern: you can stay under a limit for many months, and then "boom", you go over (and you're not happy about it).

2) Consequences

People without an abuse problem rarely will experience negative consequences. If they do, they will make an adjustment in their behavior or lifestyle and the consequence won't occur again.

People with an abuse problem, when experiencing a negative consequence, will often make an adjustment, which is short-lived. In fact their attempts to make adjustments often fail, and consequences continue and often get worse.

Consequences can be related to:

  • physical health
  • legal situations
  • emotional well-being (feelings of guilt, remorse, lowered self-esteem, depression)
  • anger management
  • family conflicts
  • interpersonal conflicts
  • job performance

3) Compulsivity

Compulsivity refers to behaviors that are repetitive and feel driven to be performed. The behaviors are disruptive to a person's productivity or well-being.

People without an abuse problem, when thinking about drinking or getting high, can take it or leave it. Their daily lives move forward without much thought about whether getting high is in the picture.

People with an abuse problem spend a lot of time thinking about and planning activities where they can drink or get high. Many of their life activities are focused on whether getting high will occur. And if there is beer in the refrigerator, it will be hard to let it sit there unused.

The "Three C's" is not just a handy screening tool. It's a great way for my clients to begin to explore some of the specific issues related to their substance abuse behavior and to help them make their own mind up about the issue. 

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