silvi2157 despairs about her granddaughter who has both mental health and addiction issues. She has recently talked about suicide, and continues to make destructive decisions that impact others around her. Where do we start in trying to get her the help she needs?
Co-Occurring Disorders: Mental Health vs substance abuse: Which do you address first.
My 20 year old granddaughter is going through a very emotional and stressful part of her life. Things are spiraling out of control. I can only imagine the reason for her addiction to cocaine and alcohol is because she does not have the coping skills to deal with the trauma she experienced for several years living in the same household with her step father. Recently she has become and shared that she is suicidal. She "doesn't feel anything" "I don't see nor can imagine anything in my future". She is finally in an intensive outpatient drug & alcohol treatment program, but is not participating consistently. She only agreed to outpatient treatment because because it is part of an agreement she has with her older cousin. In exchange for free rent (room & board) she must stay in school and participate in treatment. Read the full comment here.
Your 20 year old granddaughter was just evicted from her cousin’s house for letting a strange man in. She is inconsistently going to her IOP program. She is in danger of losing her job and has talked about suicide. She is using alcohol and cocaine and has a history of trauma. She is likely having unsafe sex with multiple people.
Your granddaughter is lucky to have a cousin and grandmother who are trying to help. The situation is serious. Having just lost her place to live, inpatient treatment is the safest place for her. Whether she tells the program or you do, she needs to be considered as a homeless person. This can help prioritize her if there are wait-lists. With this designation, the program should also be thinking from the start of where she can go to live next.
Talk with your cousin. Explain that you are going to research inpatient programs. In Massachusetts, this could be crisis stabilization: a state funded program available in all regions of the state. It keeps people on average 2 weeks and then steps them down to a transitional program while a bed in a residential program is located.
Please ask the cousin to give you a couple days to locate treatment. What is available in your granddaughter’s state? Can the family afford private treatment if nothing is available publicly? Talk to the IOP and get their input on where she can go now that she is homeless.
Who is closest to your granddaughter? Who is she more likely to listen to?
While a crisis can lead an individual to become willing to enter treatment, it is not always the case. You see the situation as a crisis; her perception of it may perhaps be limited to being “thrown out.”
For this reason, along with detailed information about inpatient treatment that is available, include information for a homeless shelter or shelters nearby. She needs to feel the consequences of her use. She needs to understand that she is homeless if she doesn’t agree to go to inpatient.
Psychiatric wards are very limited in what they do. Typically, they aim to stabilize and release. It’s a shame because she clearly needs thorough evaluation and strong support. The other possibility to consider is a civil commitment. We provide information about this in our the News & Resources tab, under the Massachusetts Message Board.
She may lose her job or quit school in all this. Her situation is too urgent to worry about that right now. These are not the things to focus on for her immediate well-being.
As her grandmother, perhaps you say something like this:
I know you’ve been trying to go to addiction treatment. It’s hard. You are really struggling. I need you to be safe. I am so worried about you. I reached out for help. The professionals I spoke to believe you are in serious danger. They suggested I find inpatient treatment. Here is the list of options I came up with. Please choose one. Let’s get you safe and in a better place. You are my granddaughter. I love you dearly. Please. You are spiraling out of control and I need you to look at this list with me and say yes to treatment. If you aren’t ready for more treatment, I added a homeless place where I can take you.
Your granddaughter’s cousin could be in this loop. She may even be the one to say this, if you think your granddaughter would be more likely to listen to her.
Your granddaughter is 20. Legally, she is an adult. She can say “no” to help and there is not much you can do about it. The Learning Modules will help you and her cousin mobilize around her in the most effective way. Don’t skip the modules. Your granddaughter is in need of more intensive help now, and maybe more later. The modules will help you understand what you are seeing, and to become the most effective around her. Practicing with these in the long term helps make shifts in your communications that can make a huge difference in how she opens up to you about her troubles.
As you said, your granddaughter may also have mental illness problems, but it is quite hard to disentangle mental illness from trauma from active addiction.
We provide information in the Resource Supplement for trauma informed addiction programs.
Many people with addiction also have a history of trauma. The addiction field is quite aware of this and there are programs designed to treat this. Dialectical behavior therapy (DBT) is a well-studied approach useful for people with trauma. See our page in the resource supplement.
Let us know if you are having any problems finding treatment. Let us know too, if there is money for private treatment and whether she is covered by insurance. Tell us which state you are in. You can do this offline by sending me an email within the Allies in Recovery website.
Grandparents are having to step in with addiction. Thank you for being there for your granddaughter. Together, let’s get her into intensive, long, and quality treatment.