I’m Leaving the Country, But I Want to Help Her…

In a recent comment, AiR member iloveher expressed deep concern and asked for guidance  on how best to be of help to a Loved One battling with cocaine, alcohol, mental health issues and trauma:

I wish I knew about this website months ago. My girlfriend (no commitment) is struggling with a substance (cocaine) and alcohol abuse. I don't think she is physically dependent on alcohol. However, it creates an anxiety disorder when she drinks or at least when she mixes it with substances. I clearly had no idea about how to deal with someone who abuses substances. It made it harder to be in a romantic relationship as I was faced with a lot of lies and deceit. I wanted to stop this romantic relationship and stay friends but that fueled the abusing alcohol and substance. Then, I decided to stay in and find out what she is dealing with and eventually help her as I know there is nobody else can help her including her family (extremely religious, judgemental) except for one or two sisters who may be understanding or may be judgemental as well. I wish I knew a solid way to make them realize that this is not a choice, it's a disease. Our relationship has many more complicated elements to it as I am truly in love with her and also leaving the country and her in a month for good. She knew this from the very beginning and I do have to go.

I met her several years ago. 6 months ago, when we started to see each other, she was in a very dark place. The symptoms were extreme depression, anxiety, alcohol abuse, self harm, insecurity, guilt, increased sexuality, suicidal thoughts and many more. This happened almost every other day. Gradually, this cycle dropped down to once a week and stayed like that for the past 4 or 5 months. I observed her very carefully and with the symptoms I witnessed I was able to realize that she was snorting cocaine and doing it discreetly. For the times she was depressed as a result of use, she kept telling me that she is just insane (molested, escaped home when teenager, married when 18, divorced when mid 20's, self injured, hospitalized) as I was interested to know. I asked her once, why she does it discreetly and told her that it is very obvious, she denied it and felt accused and we almost got in a fight. This was a mistake because she was using when I asked. Recently, I caught her while she was using with a friend. She admitted that she uses it once a week and has been doing it for the past 6 months. She believes it is okay because this is a street one and is not addictive. She obtains it directly from dealer. Because I have seen her extremely angry sometimes, I asked her if she has ever done crack cocaine. She responded "what is crack cocaine?, I know people talk about it but I don't know what that is". I think that was a "yes" answer.

I think she knows that she has a problem with substance use and she is scared. She sometimes goes to a spa to take a steam bath. She might be trying to manage her cravings. I believe she has been using for years as she shows all the symptoms of long-term cocaine use.

My purpose is to make her be able to hundred percent honest with me so I can help her in my limited time. I have two options.

1) Stop this romantic relationship right away. This will probably cause her to abuse it more if she feels dumped. I need to find a way that I am not dumping her. Dating was not a good idea because she had to hide the use. But I am also glad that it gave me a chance to find out. I am also hoping that she will eventually understand that I am here to help. And maybe she will be honest with me if she really wants to control the abuse. Here, I have to sound like a "tough love" and have tough conversations. I don't know how tough conversations work in this case. I also don't know how it works becoming best friends after a romantic relationship.

2) Continue with the relationship and play the "reward when not using" and "step back when using" game so she eventually becomes willing to share more. But so far, she has been trying hard to make me think that she wasn't taking anything. I know she is scared that I would leave her if I found out. I do not want to leave her alone. Here, I have to be able to get my feelings out of the way which is very hard for me and almost impossible. I am also very much concerned about her. I seem like I can't really step back when she is using because she becomes extremely depressed and sad.

I plan to tell her that she should find a way to manage the things that trigger her to use. What I think is that she should leave the city and never come back as she is involved with other users and dealers too. She has been living here for the past 15 years. I think her brother is also using and they must be doing it together sometimes. Is suggesting to leave this environment for good a good idea, because of many triggers? I am debating between two options and I don't know which one would bring results faster. I think I gained a great deal of progress so far and I do not want to ruin it. Now it is time to convince her to get professional help. And I am seeking help to be able to do so.

I think my English is not sufficient to be able to express my appreciation for this web site, neither is any other language I speak. I want to help her as much as I can before I leave and I need to make sure that I am doing the best thing for her. Because "I love her"

I am touched by the love you have for your girlfriend and your willingness to help.  Really, so many people run when they see substance abuse. Thank goodness for people like you who try to understand and help.

Cocaine is a powerful drug. It takes you from 0 to 100, to the top of the world, in seconds: problems melt away, you feel mentally sharp, creative, completely vibrant. Within 20 minutes or so, however, the high fades, emotions sink, and you land somewhere below 0 … until you take some more. For someone already struggling with depression and anxiety, this emotional yoyo-ing is further exacerbated.

Your girlfriend’s mental fragility, combined with the alcohol and drugs, can put her at high risk for hurting herself. The question is what you can or should do about this with the time that remains.

What you can’t control

As you lay out in your comment, there are several things you’d like to help her with: getting her to be honest with you, to stay away from friends who use, to considering a move…. The reality though is that embracing honesty and changing one’s social network happen once there is some commitment to sobriety, not before. These things are also outside your control.

What you can control

What IS under your control:

1. your reactions to her and
2. the help you provide in shepherding her towards critically needed services for her addiction, mental illness, and the effects of serious trauma.

I must sound like a broken record in these posts, but step one is to figure out treatment for your girlfriend. 

Follow our method for finding treatment, and include something from each category of treatment if possible (see our post the "roll up your sleeves" guide to assisting in recovery). 

Your girlfriend may benefit from gender-specific treatment and self-help. As for self-help groups, call them first to learn about women-only meetings.

Trauma-informed substance abuse treatment is going to be key.  Studies vary, but the rate of past trauma for women struggling with addiction is extraordinarily high, more than 75%.

Stephanie Covington has written a great deal on this topic (http://mhcc.org.au/media/25322/covington-2008.pdf).  The federal government also discusses trauma informed treatment and provides some guidelines on what to look for (see SAMHSA's page on this). 

Your friendship will likely mean a lot to your girlfriend, hopefully beyond a romantic relationship. You are leaving the country. Your influence at this time is limited but also potentially transformative. You talk about finding the words, and the idea of tough love. You are someone serious in her world who deeply cares for her. Your words along with the list of options for help – this is what you can do.

A suggested script:

Perhaps you say something like this:

I love you and will continue to love you even after I leave. I am deeply concerned for your wellbeing. From what I see, you are at a crossroads. Taking drugs and drinking are making things much worse for you. It tears me up to see it.

Promise me you will think about what I am saying.

You have a chance of living a very different life, one that’s based on safety and light. What has happened in your life is deeply unfair. What you do going forward though is your responsibility. I want so much for you to focus on getting better. Please consider looking at this list. Before I leave the country, I would like to help you get to one or more of these places.

I have thought a lot about this. This list is the most important gift I can leave with you. Please consider trying. I love you.  

Your insights are impressive, your commitment heartwarming. Thank you for caring and my very best wishes.