We Need Help with the Treatment Options List

Mountain Laurel has asked for guidance with preparing the List of Treatment Options for her Loved One. She and her husband are nervous about this step, fearful of getting it wrong. Module 8 gives you a good how-to, but no two lists will look the same. It'll depend on what you feel your Loved One would accept, what they've tried before, what you can afford or insurance would cover, etc. Here we provide some suggestions.
 

"I have been reviewing the 'Levels of Treatment' link – really helpful. It emphasizes the need to have a professional assess the best fit for LO – and this makes so much sense.

Do you recommend putting together a list of professionals who can do this work to then share with LO during a window of relatively open communication? And do you recommend an individual physician with this specialty as best option, or having a range?

I imagine I am not alone in being so fearful of screwing up this step – and yet my husband and I have to dive in. Last winter, we requested that our LO consider watching a TED Talk about the Sinclair Method – which he agreed to. After some delays, he did engage; we helped him (at his request) find a distance provider who gave him the prescription after some required steps. He took the medication as prescribed to the best of our knowledge for a period of months, and his alcohol use diminished considerably. In recent months that has fallen apart. There have been prior times when our son has agreed to take a step as well – but things are becoming more acute we feel.

Our loved one is on Medicaid in RI. Thank you for any guidance."

Should we include a medical professional on the List of Treatment Options?

You pose two questions, Mountain Laurel. The first is whether to point your Loved One to a professional for an evaluation. If your Loved One is resistant to getting help, you may have only an occasional window of opportunity (Module 8) to pitch your planned and scripted request (Module 8) and engage your son into treatment. If the evaluator is prepared to help with accessing the treatment he or she suggests, then this could be your first move.

With a Loved One who's resistant though, you may need to push the treatment itself; within which an evaluation can take place. There is still no harm in putting a medical person who can evaluate your son on the list. The words of a doctor, with their position of authority, can cut through resistance. So put it all on the list, give him choices, and subtly push what gives you the biggest bang for your buck. If he is more willing to get back on Naltrexone (the Sinclair Method) than he is to see someone new for an assessment, let’s get him back on Naltrexone first. 

If the treatment method didn't stick, do we cross it off the list?

I am glad to hear that the Sinclair Method worked for a while. The Sinclair method asks the person with the alcohol problem to take Naltrexone before drinking. It has to be a daily Naltrexone tablet, according to Sinclair practitioners. When the person drinks after Naltrexone, the euphoric feeling from the alcohol is blocked. This discourages further drinking.

As a former drinker and Naltrexone and Antabuse taker (Antabuse makes you sick, you break out in patchy red spots all over when you drink on it), I can tell you the hardest part is making yourself take that pill every day. I’m a schemer by nature. I would plan out a using episode, which in those days had to include duping the nurse who gave me my daily pills. The relapse starts way before the liquor hits your lips. (PS. I schemed my way around it. Ended up drinking with no effect and breaking out in red splotchy dots all over. A lovely look.)

The Sinclair Method worked for your son for perhaps a couple months. This is huge!

As your son is currently living with you, you could suggest a limited social contract whereby you dose your son with Naltrexone? Tim Farrell suggests this (see article in Resource Supplement: Behavioral Couples Therapy). At some daily, appointed time, your son presents for his pill and you see him swallow it. Farrell suggests a little affirmation or some other way to ritualize the experience for the two of you.

It is understandable that when a treatment “fails” we start looking for something else. I am questioning whether the Sinclair Method, in your son’s case, failed. It sounds to me like it worked for a couple months. It bears repeating, this feels promising!

MAT is a great start. For most people it's not enough.

Taking Naltrexone, like any other Medication Assisted Treatment, is likely not enough for your son. So on your list, be sure to include peer meetings (see the list of online group meetings we compiled in the Resource Supplement) as well as a therapist, partial day programs, inpatient, along with the details of the local detoxification unit in your area.

Rhode Island is one of the best organized states I’ve had the pleasure of working in. Medicaid is probably the best insurance for substance disorders. Medicaid, as opposed to private insurance, often covers more when it comes to SUD. To everyone, please check this before making a move to switch your Loved One’s insurance but it is worth a comparison of benefits to see if this could be the case for you.

I hope this helps. Can you provide us (offline, in a private message or contact form) the provider at a distance that offers the Sinclair method? We’d like to check it out and provide it to others.