He’s Far Away … But Is He Out of Reach?

AiR member sugarplum shares the story of her adult son who lives “out of reach” with his addiction and mental health issues and wonders about how she can still help to tilt the scale …

“Thank you for the reply! Of course, there’s a lot more to the story. My son lives in a different state and has an elderly dog who needs care. He is deep in credit card debt and has lost job after job over the last several years. Unfortunately, he’s a bartender.

Last spring he told his girlfriend and my husband that he was going to kill himself – maybe not today, but that it was inevitable. She said he had a plan. The cops and the ER botched the situation badly, and an opportunity was lost to get him immediate help. He stayed with us for the summer, which is when I got a good look at his addiction for the first time. He detoxed himself here quite easily, stayed sober for a few weeks and got a job, stalled on getting into therapy that we offered to pay for until he got health insurance, started drinking again, lost the job and moved to a different state without having followed through on our request.

He was significantly depressed as a child but never treated, and inherited my family’s strong history of serious mental illness. He knows he probably has a mood disorder that he’s been medicating with alcohol for years. Although he has expressed willingness several times to get therapy for the depression, he strongly resists going into treatment for the addiction. Clearly the drinking has skewed his thinking.

He’s a really smart guy but had difficulty in school because of the depression, bombed out of college his first semester, tried again three times and has convinced himself that he can’t be a student. So the only skilled experience he has, including several years working in high-end New York restaurants that gave him status and a good resume, feeds both his sense of accomplishment and his alcohol abuse. I think for him the life change required to stop drinking is too overwhelming to think about, and I will need solid answers from the professionals about what community support is readily available on the other side of treatment – housing, vocational counseling, training or education, employment, and of course the mental health issues that have been there long before the addiction.

My husband and I have been paying his rent since his SOS in February (“I f—-d it all up again, Mom”) after he lost his job, fell behind on the rent, got people mad at him, etc, with the stipulation that he get health insurance and therapy immediately. Navigating the health care system is not easy for him as a newcomer to his area nor for us at a distance. We try to help our three grown children with the important things, but we are not people of means and can’t continue to support him for long. He is welcome in our home if he’s in therapy or IOP treatment but has said living with us would be horrible and he wants to stay where he is.

So I can’t drive him or walk his dog, and our ability to pay has limits. Right now he is training for a new restaurant server job, has gotten Medicaid and has an appointment with a therapist next week. I would like to insist he go three times a week. I don’t want to see him stop therapy when he’s earning again and doesn’t need our help with rent. And the next time – I have no doubt there will be one – I don’t know what I’ll do!

My hope is that a good therapist will be able to connect with him, help him stabilize and deal with his day-to-day difficulties, begin to address the mood disorder and win his trust so that eventually he’s able to see that the addiction has to go and that life without it is possible. With the suicidal ideation in the picture, I think a hard-line forced detox-first approach is dangerous and that keeping him engaged is key.

My first husband was a heroin addict, my daughter is a recovering alcoholic with thirteen years of sobriety, I was in ACoA for several years and all of my big family has experience with mental health treatment. My sister is a dual-diagnosis therapist who has been very helpful. So I do know my way around the territory a little.

I hope you will accept this longer story because I need advice on walking the fine line between support and enabling, how to leverage his cooperation with our temporary financial help, what to say and not say to him, and how to deal with the fear of letting go of a grown child who has come to the point of wanting to end his life.

Thank you.”

Walking the line between support and enabling is complicated – especially when your Loved One lives far away. The only means to assess your son’s use is by phone or internet. CRAFT was designed for families who have almost daily contact. The principles can be applied to your situation, but much less precisely.

Your story lays out the difficult reality of mental illness and addiction. You have found that your son is more willing to talk about depression than his alcohol use and you have guided him towards getting health insurance and a therapy appointment.

He knows that your financial support with rent is temporary. It’s not too much to ask your son to sign a release with the therapist verifying his attendance, nothing more. You are not interested in the content of their discussion but you do want to see that he is going. This won’t be easy to ask for and may need to wait a couple weeks, giving them a little time to establish a rapport.  It would be ideal if your son could see the therapist three times a week, but this is out of your control. The frequency of treatment is a clinical decision made in partnership between the therapist and your son.

You have been through a great deal with your family. From the account you give, it sounds like you have done what you can. The housing is temporary; your son has an appointment with a professional. We have to hope the professional is good and is able to establish a therapeutic alliance. It must feel so far out of reach, and it is. Your control over the situation is limited. There is no such thing as a forced detox, short of an involuntary commitment.

The message that you must continue to convey to your son is that you are willing to help with treatment, and for a short while, with rent. The rest is up to him. When you talk on the phone, keep it light. Try to stay out of the details of the treatment. If he is high, find a way to end the phone call.  If he is not, find some positive things to talk about.

Depression and suicidal ideation are serious. How this interacts with the alcohol is for the professional to determine. I really hope this person is good.

Despite being far away, you can still research what is available in his area. Call the police and find out whether they will do a wellness check.  How would you request an involuntary commitment and where would he be sent and for how long? Where are the IOPs, the detoxes….make a list and give it to him.

Are there SAMHSA-funded grants in his area that provide treatment? Grants don’t depend on insurance. Look up professors at the local university psychology department. See if they know of treatment funded by a grant or free clinics. Follow our list of treatment modalities in this link. See if you can locate something under each of the categories we lay out in this post. Follow our method for finding treatment here.

Along with the rent and the therapist, making this list and giving it to him is something else you can do.

If Adult Children of Alcoholics (ACoA) was helpful, consider going back or consider Al-Anon.

What we’ve laid out here is what you can do. You are prepared and you are supportive. You are doing what you can to keep yourself calm. You don’t have to let go of your son: your hand is outreached, you stay in contact, and you provide him with options.

You have lived a long time with addiction and mental illness. Your family has been deeply affected. It is heartbreaking. Do what you can for your son and I hope you can find some peace in this storm.