lbprof4 and his family have gone to great lengths to help his teenage son manage his SUD and yet, the use, the dissimulation and the destructive behavior continue to rage. The entire family is on edge, feeling like they have used all their energy to no avail. With their Loved One quickly approaching majority, they need guidance on how to shepherd him towards sobriety and on how to provide him the tools he needs to go out in the world on his own.
“Our son, 17, has been using weed and some pills (e.g., Xanax), but weed seems to be the primary substance. He has been in two residential programs (Nov 2019-Jan 2020) and another one (May – June 2020). He has been diagnosed with ADD, social anxiety and depression.
After his first residential program, he stayed sober for about two weeks. He was in an IOP but eventually got dismissed for failing three drug tests in a row. During the start of the lockdown during the pandemic, his behavior got more erratic and dangerous for him and for our family. He would not follow the protocols established by our city (he would continue to sneak out to buy and to party with people, none of whom were wearing masks or socially distancing). His behavior became more violent (yelling, breaking things, pounding on the door when we would lock him out). Eventually we had him living in our partially furnished garage. When his behavior did not improve, we even had him sleeping in a tent in our backyard. We provided him with food and water, and he had books for writing and reading. […]”
Read lbprof4’s full comment here.
We’ve done everything in our power but the lying and dissimulation haven’t stopped
Thank you for writing in, lbprof4. I believe your situation will sound familiar to a lot of our members and therefore this post may be helpful to many.
At 17, your son is using cannabis and benzodiazepines. He is slipping around all your efforts to get him stable and to not use drugs, despite your family’s following CRAFT principles. You have gone so far as to set up a tent in the backyard and to rent an apartment 30 minutes away, where one of you would trade off staying with your son. You wonder how you can protect your son from homelessness, especially during COVID, and get him to conform to house policies.
Your son is now 17, you are about to lose what remains of your ability to “force” him to do anything. CRAFT has shown you how to respond to your Loved One, which has helped get him into treatment several times, though the problems with drugs persist. You are also concerned about your son’s ability to keep up with school, maintain basic hygiene, and generally be a good citizen in your home. You have the added concern of his two younger sisters who are understandably caught up in the situation.
I love the idea of pitching a tent in the backyard complete with food and water delivery. I applaud the lengths to which your family has gone to help your son.
He’s not a child anymore, living together is tough
17 is a tough age. The young person is pushing hard for more independence, and this includes the right to smoke pot, your son would likely say. For you, having a 17-year-old means you continue to offer guidance and make propositions but also means you gradually let go and learn to be less and less attached to the outcome. “Letting go” is vague and could mean so many things, but I’d encourage you to keep thinking in terms of letting go of expectations and outcome, or of the parent-child dynamics which are fading fast as your son comes into adulthood.
As children become young adults, each family needs to learn their own special dance that allows the parents and the children to give each other breathing room and independence, to be and express what they each need to. That being said, when those young adults are choosing to live under our roof, and we are choosing to let them do so, boundaries and mutual agreements are nevertheless normal and necessary.
Communication is your #1 friend…
…and silence might be a close runner up
There may be lots of tweaks we could suggest you try. It’s always a good idea to review key modules to find more recommendations and to keep your family sharp and motivated. Motivation for changing how you communicate is hard to keep up, especially in the face of what appears as failure to you.
Communication is the one place where you can achieve the most, however. I was reminded recently what an amazing strategy it is for me to consider saying nothing!! I try hard to keep that option in the front of my mind when I deal with difficult people in my life. I find my first responses are still too reactive (Yes, after all these years, reaction is reaction. Reactions don’t stop happening, they just get shorter and easier to tolerate as we learn to more mindfully watch ourselves. One has to actively fight the biases caused by our expectations and vulnerability).
We’re not seeing results despite CRAFT and treatment
My hunch is that you and your family are doing everything quite well. What you’re up against though, especially true with this age group, is continued use despite treatment.
Even the best evidence-based short-term treatments designed for youth with cannabis use are underwhelming in their outcomes. Here is what one groundbreaking study —looking at different treatments for adolescents with CUD — had to say about relapse:
“When relapse patterns were further examined over the follow-up period, it was found that half of the adolescents went in and out of periods of recovery and relapse one or more times after discharge. Two thirds were still reporting substance use or related problems at the 12-month follow-up interview. Thus, while the Cannabis Youth Treatment (CYT) interventions were relatively effective as initial interventions, they were not enough to interrupt all future substance use and problems for many adolescents. For significant subgroups of clinically referred teens, the conceptualization of their drug problems as a chronic condition suggests the need to focus more on monitoring and re-intervention or continuing care.” 1
So, even with expert, pristine treatment conditions, families should brace themselves and expect relapse. You are unlikely to fully stamp out the use of drugs by your son. Rather, you are going to aim to reduce his use, as you have been doing, by 25% or so.
A shift in your expectations may help you go easier on yourself and your son. Laurie MacDougall just published a brilliant post in which she explains how transformative it was for her to redefine her expectations of what her son’s recovery should look like. It can be so helpful to look at your situation from a different angle.
If you happen to also read the article which the above quote comes from, you will see that ACRA (Adolescent Community Reinforcement Approach) not only performed well, but was the most cost-effective of the five interventions studied. The CRA of ACRA is the same as the CRA in CRAFT: Community Reinforcement and Family Training.
Community Reinforcement to keep the social anxiety at bay
One of the tenets of this approach for adolescents with cannabis problems is to find community activities (“community reinforcement”) that substitute for periods when the youth would typically use. This makes sense, and is the reason why a high number of kids your son’s age do eventually mature out of problem drug use. Young adults turn their attention to things that “hook” them: a career goal, a sport, volunteer work, etc.
When I think of your son, I think about his social anxiety. Being at ease with people in life is a big deal, and not one that is often enough the focus of change. Your son has learned he can take a benzodiazepine when he needs to manage his social anxiety. This helps with the symptom but not with the cause. It also teaches him to take a pill or smoke a joint — a quicker, easier fix — as opposed to use coping skills. Not to mention it is a drug people misuse, and can be life-threatening to withdraw from without medical supervision.
Many people with SUD have problems being social. Many cancel obligations. They have trouble showing up for life because it means being in public, which causes stress. They take something to help them to be with others or to go out in the world. Another strategy is to meet their need for connection with peers by finding others like themselves, who are eager to focus on a joint.
John Kelly, at Harvard, studies peer support for people with addiction (like AA and SMART Recovery). He is finding that being in a group is a key piece of peer support success. Being part of a group of like-minded people builds a bond, and the skills for being social outside of peer support.
Two ways forward, two levels of engagement on your part
I am going to suggest two ways forward. The first is to accept that this will be a difficult year for your family with yet some more modifications to your daily life.
One step, which could provide great relief, would be to find a family therapist who is willing to work with your entire family (with or without your son, as he chooses). This provides your daughters some specific attention.
Next, let’s look at how you can use your home as the ultimate reward for non-use:
The garage vs. your home
Is the garage heated? Could you envision your son living there, using your house only when you are home and only when he doesn’t look high? (Module 3 helps you recognize signs of use).
You might establish regular timeslots for remote schooling and homework done in your house. Perhaps there is no internet service in the garage? The house becomes a reward for food, internet, a shower…
Whatever happens in the garage, within some reasonable guidelines, is your son’s business. This includes bringing a woman over for the night (alas for you).
Your son takes his medication in front of you each day
He agrees to do something to address his vulnerabilities
Be it therapy, AA/NA or other peer support, exercise, creative activities; his choice. In this deal, you’ll have food, internet and the shower, to leverage against not being high in the moment, doing his schoolwork, and getting “help” — using the widest possible definition of the term.
You stay motivated to continue doing CRAFT
Perhaps you make a habit of watching the video modules regularly, returning to the Key Observations exercises (things change), writing in your private journal and reading blog posts both on the Discussion Blog and on the Sanctuary.
In your comment, you talk about how much you have worked on your communication. Keep doing what you are doing. Positive communication, even though it might not feel like it now, is helping to maintain the bond between you and your son and to shepherd him towards sobriety.
All this helps get him through graduation and hopefully provides a clear boundary between your son and your home (and daughters) throughout this school year.
Plan B is to find and pay for a long-term young adult program
If you decide to do so, it would be ideal to find one that would speak to his possible interests, such as:
horticulture, or farming
urban cool living, or any other interest.
We’re talking 12-18 months in duration.
There are families on this site who have sent their young adults to such places. If you’re reading this and have a good review of such a program, please let Ibprof4 know by sending a private message through the site.
You’re not doing it all in vain
All parents of young adults are challenged in many ways, having to navigate an ever-changing relationship with an evolving young person who is shaping and affirming their identity each day. This challenge is even greater when substance misuse is involved. I am in awe of how much you have done for your son, of how committed you are and of how much you are willing to question the status quo.
I can tell, from reading your comment, that your son does not seem to be receptive to the love you are sending his way right now. But please know that regardless of whether he can recognize the value of your actions or not, these very actions do have a deeply positive impact on him. I am confident he will look back later with more experiences under his belt, more maturity, and more compassion, and be grateful for all you have given him and all you have taken away.
Your instincts are good, and you have found CRAFT and Allies in Recovery, which are providing the evidence-based guidelines you need to see your way forward. You are tackling this difficult time of your son’s life as a family. There is hope for him. We are all rooting for him to keep taking steps on the road to maturity and wellbeing, and for your family to find more peace going forward.
1 The Cannabis Youth Treatment (CYT) Study: Main findings from two randomized trials, Journal of Substance Abuse Treatment 27 (2004) 197 – 213 Here is a link to the full article.