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He Keeps Going To Treatment—And Sabotaging Himself Once He’s There

Photo credit: Tina Miroshnichenko

When a Loved One is motivated to seek treatment, it’s a cause for celebration. But for many that’s just one of many challenges. Remaining and thriving in treatment can be as hard as reaching the decision to begin. Malamia90’s son has her full support as he seeks help with SUD but struggles to get along with his providers. In such cases, the missing piece of the puzzle is often support for the mental and behavioral health challenges occurring alongside the substance use.

My son keeps getting help, which is great—he is willing to go to treatment, he makes the decision on his own, and he knows we are supportive of him. However, he has a habit of being like a rehab or hospital critic. He has had behavioral issues during stays. He has a high sense of what is “right” or “wrong,” and if he sees something he deems wrong (in his mind they are typically social justice issues) he pushes back, either through behavior or verbally.

At the last stay (a place that he deems the highest level of care, which he would give 5 stars), an employee who is not licensed and is most likely entry-level was watching the residents. He is probably recovering as well, and (according to my son) he made a verbal faux pas—he used the “faggot” word while watching a show with residents. My son called him out in front of everyone, saying he was homophobic.

The situation was reported to my son’s psychiatrist at the hospital. He could have stayed if he agreed not to call out employees in public for further verbal mistakes. My son would not agree, so he was let go the following day. I could only listen, not knowing the full details. But based on my son’s account, it is obvious that he is self-sabotaging. More concerning to me however is that he has this feeling that he is in a facility for the purpose of finding faults in others. I know that this might be normal—because he has no job, he feels bad about himself, feels judged/shamed by others, and so he is giving it back.

He is slated to go on Monday to yet another place. At this point I am losing hope that it will do anything for him. Even talking with clinicians about the incident he did not care about what they were saying! He told me that he resists authority. If “authority” tells him anything, he just digs in and resists it reflexively, out of principal. This is the story of his life. He frames people who are trying to help him in any situation—teachers, clinicians, etc.—as authorities, and it explains a lot about how he reacts to situations.

Now I am resigned to the fact that my son has really poor social skills, and he is just going to repeatedly have issues with other people. Forever, it feels. Yes, what the person said was not good; however, there are less confrontational ways to go about dealing with difficult/racist/homophobic people. And the reality of the world is that people are not perfect. Myself included.

Hi malamia90,

Sounds very frustrating. I can hear the hope and recognition of your son’s willingness to reach out for help. At the same time, I hear the struggle with how to break the cycle of your son heading back into treatment only to engage in a behavior that lands him out again without much progress.

Something that might bring you a little comfort is that your son is so not alone in having poor social skills and strategies. Often addiction is a complex mix of two or more factors—environmental, biological, mental/behavioral health, trauma. I bet every Allies family could empathize and say the same about their Loved One. The hope and possibility lie in the fact that there are so many people who have progressed and learned better coping skills through their recovery process. Everyone has the capability of learning and changing across their lives.

Breaking out of that no-win cycle

You wrote that your son seems to be stuck in a pattern: Go to the ER > go to a residential treatment program > find a way to be disruptive so that they ask him to leave > go back to using > repeat. The goal here would be to find some way to put a wrench in the cycle. In your son’s case, it also sounds like there are some mental/behavioral illness challenges that are getting in the way and that even the treatment staff are not sure how to handle. What if, instead of leading with substance use treatment alone, you look for dual-diagnosis mental/behavioral health and substance use treatment? And keep the mental/behavioral health in the forefront in the search for treatment.

A treatment facility like McLean Hospital (with locations in Belmont and Middleboro, MA), will have fully qualified staff able to diagnose your son and aware of how to approach him in ways that encourage more compliance on his part. They might be able to identify when he is trying to sabotage his treatment and address issues in a way that avoids giving him

ultimatums. Ultimatums are only going to put your son on the defensive. He is telling you that when he says he “resists authority.”

CRAFT includes a lot of communication skills (in CRAFT) you can use when dealing with your son—skills that would reduce his defensiveness and help him be more receptive to different ways of handling situations. There could be a cooling off period and then an ongoing conversation with him, using open-ended questions and reflective listening. That sort of approach should point him toward solving his own problem or coming up with a way to better handle tough situations.

This is a marathon, not a sprint

Everyone involved must be aware, however, that it may take him time to change. He is human and couldn’t possibly change overnight. It will require patience on everyone’s part. Also bear in mind that these are just thoughts and suggestions. Highly qualified doctors and clinicians at a hospital like McLean’s would best be able to work out a plan for your son. They’ll be fully aware of multiple strategies to address your son in a way more likely to make him stay engaged.

I don’t know if he gives you permission to speak to his treatment teams or not. Either way, though, you could let them know about his tendency to sabotage his stays, giving them the chance to find a way to prepare and strategize ahead of time.

Never forget to care for yourself

Momma, I know this is a struggle on all levels. I can hear the ruminating thoughts and the frustration of constantly searching for solutions and feeling like you’re getting nowhere. Clearly you love your son and are working hard to find ways to help him. Along the way, it’s vital that you don’t forget yourself and your own healing. It is so important for your son, for you, and everyone involved that you take care of yourself. Work on ways to calm your mind, to quiet those ruminating thoughts that don’t get you anywhere and leave you feeling a mess. Try to get the sleep and healthy food you need. I know when someone says this to me it sounds a little hollow. I can even get resentful that I have to take care of myself. But again, it is so important for all involved. How can you bring your most helpful self to the table if you’re not doing well?

I hope this helps, malamia90. We are wishing for positive progress for you, your son, and your family. Please keep us updated. You are not alone, and if you need support with anything else, please reach out.

-Laurie MacDougall


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In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. Thank you for the response it was very thorough and I really appreciate it. As an update, It has been a few months and we did consult finally with Mclean and he was admitted. They did help him although he has relapsed a few times in the interim and had a couple psychiatric episodes and needed to return. He continues to go in and then leave. I do have the ability to speak with them. I try to give my feelings re staying longer, how he gets in and then wants to get out cause he feels “better’ and he still leaves, but, I am realizing that he is the one who needs to drive his care and recovery and make the decisions. They said they are there for him when he needs it. I am taking care of myself it is really hard though! In one instance, I had to miss a workout at my usual time because of a couple unexpected things came up. I could have just gone to bed and tossed and turned all night, but, instead I put on my workout gear and did a shorter workout around 9pm at home and then was able to sleep better than I would have if I had skipped the workout. I woke up the next day and felt really good for having been consistent with my self care and my goal of getting back in pre-pandemic shape. Thanks again!