He’s Still Using…Should We Look for a New Therapist?

AiR member saddenddeeply is seeing progress with his college-aged son, but wonders if things are going fast enough. Does his son need a new therapist, given that he's still struggling with the compulsive gaming?
 

"Dear Dominique,

My 19 year old son has addictions to video game, nicotine and perhaps marijuana and failed his first semester at Cornell. Lately he has been seeing a counselor who does cognitive therapy. After many sessions, we did not see him attacking any addiction problems. He smoked e-cig at home when no one was watching even after many warnings, played video games 3-8 hours a day and told us marijuana is not addictive. He did try to do something like looking for a job although without success. We told him the only reason we allow him to be home is to facilitate him to quit addictions and we will kick him out if he does not work on the addictions. He was fearful and went cold turkey for e-cig and seems to be able to stop nicotine. He told us nicotine made him not able to sleep till 3-4 am in the morning. Now he can sleep before midnight and wake up at 8 am and feel he got a good sleep unlike when he was doing e-cig (he could sleep 10 hours a day and still feel no energy then), which is very encouraging.

Nevertheless, he refuses to quit video games. He said video games are everywhere because he has to use computer once he goes back to Cornell. We told him that's not acceptable to us. He said he does not know how to deal with difficult problems in school and he uses video games to escape from problems. When he thinks about video games, he associates them with friendship, compliment and achievements. I told him his classmates were nice to him not because of friendship or respect, but pity. He blew up and went hyperventilate. The counselor told him to plan the day for all the studies he wants to do and he can play games after all the planned work is done. We feel addictions will eventually pull him away from the work schedule he planned because they do have a pull on him.

We feel the counselor does not deal with addictions although she does give him something to do. We are not sure just by doing things his addictions will go away. Our understanding is that’s what cognitive therapy does. We feel we are doing all the work to deal with his addictions and the counselor does not work on the addictions. Do we need a new counselor? If so, what kind of counselor?

Thanks."
 

Your son left college and is now home living with you. He is struggling with tobacco, video gaming, and marijuana. You are being very clear to your son that he is welcome home as long as he addresses his use. He is seeing a cognitive behavioral therapist (nice job getting him to agree and go) but you question whether this is working. Your son has stopped the tobacco, or at least is hiding it from you, yet continues to play video games.

Cognitive behavioral therapy does two things well. First, it helps your son unpack his thoughts and build awareness of how negative thoughts are driving him to use substances/play games compulsively. Secondly, it helps your son build alternative coping strategies for triggers that typically lead him to use drugs or play games.

Reducing or limiting use is progress

From the sound of it, the therapist is helping your son to reduce or limit his use, at least with the video games. This is one common strategy with problem use, where the stated goal at the start is to reduce the problem behavior, not completely abstain from it. Reducing use is likely the goal your son chose to work on. By aiming for his goal (not yours or perhaps that of the therapist), your son builds awareness and sharpens alternative coping skills through success and failure. He is pursuing the goal of his choice, feels less controlled by the process, and is less likely to give up or to feel like a complete failure when he does use. The conversation in therapy is an exploration of what leads to use or no use — without judgment. The therapist can more easily build an alliance with your son. Together they examine your son’s behavior as he tests out alternatives to use.

Pulling out of addictive behaviors is a process of trial, error, and success. It takes time, perhaps months, even years, perhaps with varying success by object of addiction. So perhaps your son is able to stop smoking tobacco, to reduce his marijuana use, but he still clings to video gaming as a way to block out obligations, stress, difficult challenges, and negative thoughts. The therapy helps your son learn about himself, clarifies the “why” of his gaming, as well as how and what to substitute for it.

Now is the time to cultivate patience

As parents, it is hard to watch a child actively engage in a problem behavior. You are going to need to reach deep inside yourself for patience. This is a process that takes time and is learned in increments. It is probably best to stay away from this topic with your son. Let the therapist address addiction with him. As the family, see if you can take a longer view, and be grateful for the smaller changes you are seeing. Look for these opportunities to be supportive with a kind word or a smile. Your son is going to therapy. He is trying. Perhaps it isn’t 100% full on, but that can be expected. Give your son more time. Ask the therapist if there is more your son could be doing in terms of treatment, in particular a group process that could help your son with social support. If needed, follow Learning Module 8 for ideas of how to present additional help.

Thank you for writing in. From the first time you wrote in, I see movement in the right direction with your son. Thank you for being willing to work the program on this site.