My son is currently in a therapeutical boarding school. He has been there for 5 months and when asked how he is doing I respond that so far no apparent progress but at least he is safe and not using. I am quite sure he is an addict and we struggled for 3 years with multiple therapists, programs, etc., but nothing had an effect and no matter what he always managed to use/abuse various substances. His major complaint (aside from the fact of his being where he is) is that we were "crazy" to send him away when "all" he was doing was weed and alcohol. Never mind that this involved alcohol poisoning (he almost died) and smoking before school most, if not all, days (until he was caught; his second expulsion). Even though I feel that for my son a residential program was the only (and last) choice, I still suffer a lot of guilt and spend an inordinate amount of time inflicting more guilt reading what I do on the various sites devoted to the subject. In any event, you sound like a fabulous professional, and maybe my son would have responded to you, but I tend to doubt it. My question for you is that when faced with an adict who is doing poorly in every aspect of life, what would you recommend to him and his family?
I well understand the dilemma you are in with your son and clearly he was spinning out of control to the point where he could have died of alcohol poisoning - and I presume he was not learning any lessons and was continuing to abuse alcohol grossly. In my practice he could have earned his way to an alcohol rehab in-patient program easily, but one locally and with a length of stay that does not exceed 2 months. But even then I have grave misgivings about the substance use disorder programs and the assumptions they work from.
Most programs, even ones with caring staff that truly care for the youth and try their best, operate on an assumption that the only effective goal is abstinence. They really believe that kids such as yours are addicted in the way that adult alcoholics are. They believe in marijuana addiction as well. And almost all programs that specifically deal with "addictions" have a very poor understanding of mental health issues and of adolescent development.
Of course I have no knowledge of your son other than he was out of control within even an adolescent drinking subculture as he drank to the point of alcohol poisoning. I don't know about any other signs that he was in a rocky phase of his adolescent development or if his behavior might portend an underlying psychiatric problem. Often it does. We are way to quick to ascribe the problems to the substance, be it alcohol or marijuana.
My experience over 30 years of treating teenagers is that the concept of addiction - which I greatly respect for adults as a separate and serious disorder - simply doesn't apply to many teens. I believe abusive drinking takes years to develop into a true addiction, and while many youth become obsessed with marijuana it is almost never a true addiction. Heroin causes fast addiction and most repeating methamphetamine users get very addicted quickly. These are true addictions even in youth. Use of alcohol and marijuana can be very, very abusive however. We are given the Substance Abuse diagnosis, but this is a purely phenomenological diagnosis - based on a somewhat arbitrary set of criteria. They are considered to have the disorder if they incur some harm from using the substance. That certainly fits your child, but what does it mean? I believe that abuse of substances is one of many "emotional escape behaviors" young people use to avoid emotional pain and one of many "contest behaviors" they engage in to prove themselves worthy to peers; i.e. "I can drink more and faster then you!." This leads many girls to alcohol poisoning when they are just trying to keep up with male peers whose bodies can metabolize much more alcohol. Many youth I have worked with have an underlying psychiatric diagnosis that remains hidden. Kids are sent to substance abuse programs, which are not trained to diagnose mental health disorders. If they get to a mental health practitioners they find that most are so upset by the risks of the kid's substance using behavior that they blinded to, or don't want to see, the mental health issues. They dispose of the problem by sending them to D&A rehab as they fear having to deal with such risky behavior. Way too many mental health professionals, including psychiatrists just don't get what a teenager is doing when engaging in such problematic behavior and don't have the tools to manage it when (and if) they see the underlying mental health issues.
So kids get sent away to places such as where you sent your son. Maybe with luck they get out of the habit of drinking and come to grips with the dangers they incurred. But if this is going to happen it will happen in a couple of months. It is inappropriate and most often harmful for youth to be separated from their families for longer periods. If they are in an appropriate program they will be returned to their family home with an intensive outpatient program in six to eight weeks. As far as I know there is NO evidence that a longer treatment in residential care adds much, and there is some evidence that it is harmful.
It seems that all such programs subscribe to the addiction theory and demand a goal of abstinence. My experience is that most youth insincerely subscribe to this goal so as to get out of the program and as soon as they are back home they indulge in some form of substance use - usually not marijuana as that is too easy to detect with urine testing. But their use is tempered. A good result is achieved, despite an unrealistic goal. The good results seem to happen even if the staffs of the programs delude themselves, or perhaps secretly know but fear speaking heresy in a program that won't tolerate an alternate explanation for the kids resumed substance use. They may know what is going on with the kids but don't look too closely. I have yet to work with a kid coming back from even such a "helpful" program that didn't reinitiate drug and/or alcohol use. If caught using they are considered to have "relapsed," a term out of the adult addiction treatment lexicon. But it simply doesn't apply. My experience is that most teens, if using drugs as part of developmentally "over-the-top" risk taking, "cool their jets." They are more successful in using in a way that doesn't come to adult attention or interfere with their life. They have learned their lesson and get smarter, not abstinent. As they do less drugs or alcohol and if they have an underlying mental health problem, it will likely show itself as they cut down on self-medicating. At this point a psychiatrist or other qualified mental health professional can make a diagnosis and help them, as they no longer are drowning in alcohol or getting lost in a marijuana haze.
When I talk with youth, they all know this. They know what their friends are in the middle of as they go through the process of ever more stupid use of substances; getting caught and sent away for a while and then cooling it but still using when they get back. The value for most youth is to not be so stupid as to let it get out of hand. Every one of them knows that the drug and alcohol mythology is a fraud and they don't buy it. They don't because as they see their friends return from rehab they do what they likely would have done if they hadn't gone. The community of youth knows what is not cool and peer disapproval in most communities is a powerful disincentive to staying "stupid" very long. Sometimes other adults outside the family may see what is happening and have access to the troubled young person and can exercise constructive influence. And of course it is great if her there happens to be a rare drug and alcohol program which buys into the Harm Reduction Approach I am articulating, or if their is a mental health professional who knows about adolescent development and how symptoms of emotional disorders are buried in various developmentally determined escape behaviors such as substance abuse. If you find one of these you can be assured that as they forge a good relationship with your son or daughter the problematic use of alcohol or drugs can be sorted through. Even if the behavioral health professionals are all ineffectual and deluded by addiction jargon, communities that are halfway functional and exercise meaningful contingencies for kids influence youth eventually toward moderating their behavior. This is true unless there is a critical mass of youth mindlessly in self-destruct mode. Then there is a need for a community intervention, not sending kids off to rehab programs wholesale. Having such problems and NOT going into a residential program does not mean inevitable progression toward death. It usually means lots of messy situations, heart ache for parents and all sorts of social consequences; i.e. failing grades, social disapproval form many peers, trips to hospital ER's and juvenile justice involvements. Eventually youth with such problems are influenced to cool it as consequences accrue which they don't like. They get better eventually. And when they do get better it is because they learned lessons of reality, not the lessons of the artificial environments of residential programs. They are eventually much safer for having dealt with their problems in a real community.
So what does this mean for your young son? From what you say you may have chosen a place for him to go that is not as frankly abusive as some of the places we talk about on this web site. I trust you can visit him frequently, maybe even have some involvement in his treatment and find the staff humane and forthcoming. If not get him out of there quickly! But even if he is in a reasonably well-run program and you feel you have some time does consider that he is being held against his will and he is being held too long. Five months is way too long. So that speaks to problems and a need to get him out anyway. Not knowing your community it is hard for me to guess what resources you may have to help you. I am a firm believer that parents need the support of other parents who have been through such hellish ordeals as you are in. I wish I could absolve you of ANY sense of guilt as you, like all parents in your position are acting to keep your child safe as best you can and you don't have good advise and cannot be expected to know what to do. Some communities have parent advocacy and parent-to-parent supports. Seek this out and see if you have such groups nearby. I would very quickly seek a psychiatric evaluation of your son when he is home and use that as a first step in planning a treatment program for him. Do your very best to find a compatible mental health counselor who has an intuitive capacity to relate to youth. The degree is less important then a bit of charisma and an engaging style. If that can be linked with some youth program that fits your son's aptitudes then better. DO NOT CONDONE substance use, but don't catastrophist it either. Let him know that you are dead set against his using substances but know your limits in protecting him from himself. Let him know that if you find alcohol or drugs in his room or on him you will flush it or destroy it. Be very clear in your beliefs and equally clear that at his age he has the capacity to get himself into trouble no mater how diligent you try to be. Let him know that you can't lead his life for him, can't screen all of his potential friends and that you know he is on his own ever more as his adolescent years go by. Be clear you expect him to get it together so he can lead a decent and happy life. And then let him know that he must agree to be in (what ever you come up with as a treatment program) or work with you to modify it to make sure it is appropriate and relevant for him. Your son will agree to this, as he will be so grateful that you are taking him home.
Charles Huffine, MD
CAFETY
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