He Rarely Drinks in Front of Us

Tuckernuck has just discovered her son's drinking. Between his dual diagnosis, his Asberger's, his late-night drinking alone in his room, and being accepted to Americorps for this coming fall, Mom and Dad are overwhelmed with how to help him, and the specifics of rewarding non-use. Mom is also very sad, and looking for support with the hard feelings…

"Hello and thank you for being here. My husband and I are new to Allies In Recovery. We were immediately drawn towards the positive behavioral approach.

My son rarely drinks in front of us. He was diagnosed Asperger's and ADHD at the age of 3 (he is now 23). He is on a variety of medications for ADHD and anxiety and depression. We became aware that there is an alcohol problem a few days ago. I had read enough of the CRAFT information to approach him calmly about finding 8 empty wine bottles in his drawers. He told us that he had already quit drinking a couple of weeks ago and that those were old bottles.

His pattern is to stay up very late (my husband and I go to bed at around 11), and that is when he must be doing his drinking. He is very isolated and has very few close friends, except through shows, where he plays music.

He has lied to us about his alcohol use and I am trying to figure out how to reward him for non-use, if I don't know if he is using overnight or not.

Is Al-Anon helpful for me and my feelings? I am so sad.

I will start watching the modules with my husband. Which are the best ones for my situation?

Also, he has been accepted into Americorps and he goes across the country beginning in October. I am worried that they have a zero tolerance and he may be kicked out if he is still drinking like this. If he needs treatment, I would rather his getting it now."

Hello Tuckernuck: Your son is afflicted with Asperger’s, depression and anxiety, and a possible alcohol issue. He is 23, lives at home, and is planning to leave home to join Americorps in 6 months. You just discovered that he is drinking, probably late at night, alone. We wrote this blog post that talks about Asberger’s and substance use disorder, and our Resource Supplement has a page on the same subject (see here).

First off, let me say your son has courage. We are all scared of things that keep us back, but it shows courage to go towards those scary things that build character and resiliency. Good for him for playing music in public venues and for having been accepted into Americorps.
 

Rewarding non-use

Let's first talk about rewarding non-use when he is not drinking, which you are trying to do…this is important! Your son doesn’t drink during the day, only at night when you’ve gone to bed. Learning Module #6, which addresses Times of Use, talks about substance use as encompassing:
 

• the period right before, when you see they are lining up to use and there is little you can do to gently turn that around,
• the period when they are using, and
• the period afterwards, in your son’s case, in the morning when he might be feeling withdrawal or be hungover.

Now that you know drinking is happening at night, I wonder if you see signs of a hangover in the morning. Grumpy, complaining of a headache, withdrawn emotionally….. Learning Module 6 talks about pulling back in these moments, quietly, neutrally… don’t fix breakfast (or lunch if this is when he emerges from a late night)… don’t act as though everything is normal and fine. 

Remove rewards (which includes your presence/attention), allow natural consequences to occur (if he is sick, don’t tell him it will be all right), disengage…the idea is to make him feel alone and responsible for the night of drinking by removing your positive reinforcement as best you can.

Perhaps you restrict rewarding behavior to the mid afternoon until bedtime—the period when you are relatively sure he's is not under the influence—encouraging non-use by demonstrating warmth and love and rewards in that period.

When he goes out to play music, he must almost certainly drink. This is another place to consider his possible problematic use. While you are not going to influence his choice to go out and play music, you are now more aware of the morning after, looking for signs of a hangover and therefore pulling back.

Use his plan for change to help your strategy

Americorps will be a huge change in your son’s life. He will want to succeed at it. I see Americorps strategically. Here’s how.

#1 Asking someone if they are misusing a substance will typically get you one of two answers: 1) no, leave me alone 2) it’s my right to drink, leave me alone. You got the first answer.

I wonder if you could find a time when your son is not using (perhaps early evening), and make a formal request (see this exercise from Learning Module 8 on planning a request). Before sitting down with him, see what is available in your area. You didn’t mention that your son gets psychotherapy. Is there someone knowledgeable in Asberger’s and substance misuse? Module 8 talks about the specifics of treatment. Have this figured out. How will it be paid for, wait list, how will your son get there, etc.

The request could go something like this…..

"Your dad and I (the person doing the talking should be the one with the most influence) were concerned about the wine bottles. The fact that you are drinking alone at night really scares us. It may be nothing, but it also may be because you are unhappy or anxious and the drugs you take aren’t working like they should. I am so proud of your plans to join Americorps. It’s a huge opening in your life. It will also be a huge challenge. Joining Americorps is a very courageous thing."

This is up to you, but I’ve located an expert who works with anxiety/depression/asberger’s, and I’ve written down this information on this paper. He takes our insurance, etc…

I know you want to succeed, and we, too, want this for you. You have a couple months before you leave. Would you consider talking things through with an expert and making sure you are in the best shape possible when you leave in October?

If he says no, you accept this. He has the therapist’s name and can change his mind at any time. A good number of people do when they hit a bleak moment of despair, or have an 'aha' moment as they realize that creeping alcohol use could in fact cause real trouble for their plans/priorities (in this case, Americorps). I am sure your son is invested in succeeding.

#2 So then maybe he goes off to Americorps and the challenges of the job, especially the challenge of being with people a lot of the time, cause him to reduce his drinking. This is the environment influencing his use, which it absolutely can. The structure, the norm of non-drinking, the stress of wanting to succeed, can all work to make him reconsider his secret drinking.

Or maybe the stress of Americorps makes his drinking increase. For this, you will need (sorry, more work….) to find a similar psychotherapist in the area. Same little talk. “Perhaps, son, you need to add a little more support…” You could do this way before October, if he’s remained resistant to getting help through the summer, and give him the names of the therapists you have found as part of his Americorps “insurance blanket.”

For Americorps, he is also going to need regular psychiatric support to follow his use of psychotropics. Can you find that and put it on the list? Or will he come back periodically to continue to be followed back home?

Americorps is your son stepping into the world. As I’ve said, this is wonderfully courageous. Your son will either step up to the challenge and clean things up in terms of alcohol, or you will need to help him find and get to help out there.

The ultimate reward for your son is success with Americorps. Speak in terms of that, get detailed information about treatment at home and at his Americorps placement, and I think you will be doing what you can as a parent to lead your son to the treatment he will need to address the possibly burgeoning alcohol problem.

Your own hard feelings

You spoke about sadness and asked about Al-Anon for support with that. It's wonderful that you are looking to get help with your own difficult emotions. Many people find Al-Anon and similar support groups to be helpful for connecting with others, processing hard emotions, and getting the reinforcement that we aren't alone in this struggle.

At Allies in Recovery, we know that families struggling with a Loved One's substance use are dealing with a bouquet of difficult emotions on a daily basis. Learning Module 7 is about Self-Care, which is a really big and important part of CRAFT.

AiR Mom Laurie MacDougall recently reflected, "How can I help somebody else if I'm a mess?".

Self-care for the family member is not optional when you're working the CRAFT program. On the contrary, it's the fuel that the family member will use to get where they want to go. From dealing with the hard feelings, to making time for your own needs and pleasures, to prioritizing a balanced, more centered state for yourself, you are not only providing a model for your Loved One, but you're also putting yourself in the ideal state of mind (and body) to be a strong support for them.

Check in again and let us know how it is going. Other families in the AiR community are dealing with dual- or even triply-diagnosed Loved Ones. Thank you for your question. It is helpful for all of us.