An AlliesinRecovery.net member has written in for help surrounding how to communicate effectively with her son. Specifically, she wants to talk to him about getting some help with his mental health issues that exist concurrently and unquestionably challenge his substance misuse and recovery as a whole. Watching their loved one spiral downward is making the entire family feel distraught, and mom speaks of feeling like she’s “dying inside.” We answer with some CRAFT-informed ideas – with a 60-70% success rate at shepherding a loved one into treatment – to help her approach this tricky issue.
“Please help me with the correct words to have my son seek a psychiatric evaluation for bipolar to help understand the underlying issue of substance abuse. If he could be under a doctor’s care with prescribed meds that he can personally handle, it could help his situation when he spirals downward again. This has been a vicious cycle since he returned home from college three years ago. It is tearing me apart. It has affected all of his employment opportunities and now he is losing friends as well as his girlfriend. HELP. I am dying inside. I am NOT suicidal, just distraught – and his father, brother, and sisters are as well. Please HELP!”
Welcome and thank you for your question. I will give you the words below. First, though, allow me to point out a few things that may help you and others reading this post.
Seeking to assess and diagnose untreated mental illness is one important avenue to pursue
A psychiatric visit for untreated bipolar illness is indeed one important avenue to go down to help your son. Does he show less resistance to having his mental health treated than his drug use? Is this the reason to start with a psychiatrist? Or are you thinking that taking a pill safely could help dampen his addiction to drugs? If you had to guess, what might your son be willing to consider in terms of help?
When the family sees 100% resistance, is it really 100%?
Families often tell me, “Nope, tried that, he’s not interested in doing anything!”
The family sees 100% resistance.
But is there truly 100% resistance? Being able to identify, and act appropriately on, even 1% of motivation, is one of the family’s best tools in the CRAFT toolkit. In our AlliesInRecovery.net eLearning Module 8, “How do I Get my Loved One Into Treatment?”, we talk about motivation and resistance for change and how motivation shifts internally, up and down. We teach the family to watch/listen for these shifts by learning to recognize “change talk”.
“Change Talk” is described as when your loved one expresses a “wish” or a “dip.” A “wish” is when your loved one talks about the need to improved their life, such as a comment about getting healthy, joining a gym, or a desire for something that is currently of reach, like school, a driver’s license, or a vacation. A “dip” is something that dampens their outlook; something that caused your loved one embarrassment or shame. Maybe their boss smelled alcohol and said something. Or perhaps the talk is about feeling sad or anxious. In short, “change talk” is your loved one’s own motivation for change poking through, and it presents the opening for you to suggest getting help.
Is your son totally shut down, totally unwilling to do anything whatsoever to help himself? There’s a good chance that he isn’t; a good chance he does want change.
Perhaps he sounds ambiguous about his situation, one day agreeing and saying he’ll do something, the next moment saying he’s fine and to leave him alone. This flip-flopping is felt by families as manipulation or lies, and adds to possible discord.
Using Behavior Change theory helps you successfully apply CRAFT
Behavior change theory holds that there is a stage in any behavior change where the person contemplates the pro’s and cons of changing a behavior, and thinks about addressing that problem behavior.
Let’s take a night of blackout drinking by someone with alcohol problems. Perhaps the internal contemplation sounds something like this (the “pro’s” and “cons” are within the framework of wanting to move toward change):
My head and body hurt so bad right now (pro behavior change), and I don’t remember what happened at the end of the night or how I got myself to bed (pro). I drank too much (pro). I need to do something about the drinking (pro), but right now I have to get to work (con), so I need this beer to straighten me out so that I can get moving (con). I’ll think about this (pro) but not until after my sister’s wedding next month (con). I want to be able to drink then (con). So, I’ll think about this another time (con).
I think any one of us can relate to this back-and-forth in our head when we need to change a behavior that is causing us problems. This back-and-forth is a sign that your loved one is thinking about a change.
Timing is KEY. Also, anticipate possible roadblocks…
So, timing is important. When you talk to your son about treatment, try to do so in a moment when he’s already thinking about change. Train your ear to listen to him better (our AlliesInRecovery.net eLearning Module 4 trains you in “Reflective Listening”), and attempt your little intervention on the heels of a wish or a dip (see above). If this isn’t possible because you’re not hearing change talk, move to a “Planned Conversation” around the kitchen table. Our AlliesInRecovery.net eLearning Module 8, discusses how to do this in detail; we outline some of how to do this below. The best timing for doing this is when your loved one isn’t using, or at least not very high.
You are asking how to intervene with your son to engage him into psychiatric care. Is your son more willing (in degrees) to get help for his mental health than for his use of a drug? CRAFT recommends aiming for the issue which your loved one is most likely to agree to getting help for. It certainly can be mental illness, like depression or anxiety (BTW, calling it “anxiety” or “depression” may feel less stigmatizing than “bipolar”).
Before talking to your son, you will need to research and write down a list of possible options for help. Include mental health treatments, self-help, substance use recovery, online options (in our Resource Supplement for AlliesInRecovery.net members, we created an all-online resource list.)
Run through the barriers to each of the options and try to resolve them beforehand: Waitlist (“I was able to get you on the waitlist”), transportation (“I’ll drive”), insurance pays? (Yes; or if not: who pays?).
Workarounds can sometimes be OK
One thought here: Why look for a psychiatric evaluation if your son has already been diagnosed with bipolar illness? I bring this up because waitlists for psychiatrists are very long right now. You may have more luck finding him an earlier appointment with a Psychiatric Nurse Practitioner near you or online. Since he likely has a medical record that includes bipolar, the nurse can re-evaluate, and decide whether and what to prescribe. Getting him in to see a specialist nurse could save time and money.
Since you are headed into the world of mental health treatment, it might be helpful to give the mental health treater a heads up about the drug use. Our thinking is you are not in a fair fight. If you can give your son a slight advantage by tipping off the treater to know what to look for… score 1 for both the family and your son.
Preparing your request that your son seek help
You’ll benefit a lot by looking at our eLearning Module 4, “How Do I Talk to my Loved One?” before starting, since the cues have mostly to do with how you say stuff. Below are some examples and considerations for how to do this:
Who’s doing the talking to your son?
You and/or his dad? Who does he look up to especially? Who typically isn’t the one bugging him regarding treatment – perhaps they give the little speech.
Restate the wish or dip you just heard your son say:
I hear you, you’re angry and fed up living with me (avoid the word “us”). I agree with you, something needs to change.
Show compassion… praise or somehow recognize the attempts your loved one has been making to improve their life. Start with an “I” statement… (I know you’ve been struggling; I’m so proud of you for cutting back on weekdays, etc.)
I know this setup isn’t ideal. I have come to understand how hard this is on you. I thank you for trying (name of few things that over the last couple months show a little effort on his part). My sense is that you try and still you sink low.
Own your part… (I know I’m the one who has been pushing for you to do something about your drinking/drug use/anxiety/depression)
I’m sorry for my part in all this. I really want you to feel better and to get your life back on track. I know I’ve pushed you hard in the past. I haven’t understood what you were going through. I want you to know I have reached out for help for myself. We are all in this together. I am trying to understand.
Say how it makes you feel… (I feel so overwhelmed by what is going on with you; I am so scared for you…)
I’ve been scared. I get angry when I’m scared and I’ve said things I regret. It pains me to see you struggling. I love you dearly.
Offer to help… (I have this list, I have the name of a counselor, I have a few options… Can we look at them together?)
I’ve put together a list of options (put mental health treatment on top). Some of these I’ve called to make sure you can get in. I’ve put all the details on the list. Will you look at it with me?
Will you consider trying one of these? Perhaps we can make the call together.
Is there something else we can do together to head off another downward spiral?
If the answer to treatment is “no,” you thank your son for listening to you, and tell him you will talk again.
The list goes with your son. If he doesn’t take it, put it discreetly somewhere he has access to it.
The rest of the time, say as little as possible about getting help, treatment, illness, addiction.
This small intervention, usually done weeks into adjusting your behavior and communication (our eLearning Modules 4-6), has shown to be 60-70% successful in shepherding a loved one to treatment. If it fails, you will have other opportunities when you hear change talk to set up and try again. Your son will have the list. The next time he wakes in the middle of the night and things look bleak, he may just make that call.
I hope you and your family will look at our entire set of eLearning modules to further improve your end of things. Being unified, compassionate, and ready to drop everything when you hear him say it hurts (a dip) or when you hear him say he wants more from life (a wish), is one important path through.
One last point. I would say that feeling like you are “dying inside” is an extreme emotion, yet I, and others on this site, completely understand what you are saying. You can quickly help yourself to feel even slightly better by going to our eLearning Module 7 “How Do I Care for Myself When Negative Feelings Get in the Way?” which is our half-hour course on how thoughts affect feelings; it shows how to get the better of our negative feelings by learning not to distort our thinking by bending it towards the negative. Many members have called Module 7 a lifesaver.
We are with you. Keep us posted.
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