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If Suicide Is a Risk, How Can We Help?

Suicide

An Allies in Recovery member writes about her brother’s heroin use and how her family is handling the situation. Her brother has alluded to the possibility of suicide. They are all frightened he might take his own life at some point. Only one family member still gives him a little money and he can come to their parents’ house for laundry, showers, dinner, and to see his daughter. She wonders how to apply CRAFT and natural consequences when suicide is a real concern.

This post originally appeared on our Member Site blog, where experts respond to members’ questions and concerns. To sign up for our special offer and benefit from the Allies in Recovery eLearning program, click here.

Dominique Simon-Levine responds to this concerned sister whose family is walking on eggshells

The talk of suicide is indeed very worrisome and can stop families from allowing natural consequences. The fear is that taking away money, or not answering their phone calls, or leaving them alone when high will lead the loved one to suicide.

To this I add two other frightening behaviors that stop families in their tracks when it comes to instituting changes in the family dynamic towards the alcohol or drug use. The first is the threat of overdose (or for that matter, any dangerous behavior like driving drunk) and the second, in adolescents and teenagers, is the threat of running away.

There are a couple reasons to worry about your brother’s situation. The risk of suicide is higher among older males, those with the means for suicide (like guns), and the crisis he is going through with his divorce. Suicide is also higher in those who abuse drugs or alcohol.

 

Get professional advice first

The first suggestion I would make is for you to get the advice of a psychotherapist. Your family is going to need the help of a professional to assess the degree of risk and how the family should respond to it. Getting a psychotherapist on board now helps you and sets the stage for your brother to be assessed. Take the suggestions we give in Learning Module 8, (available on our member site; watch an excerpt here), on how to get your loved one to enter treatment and engage your brother to agree to be properly assessed. Explain that this is just a one-time meeting—he doesn’t have to continue if he doesn’t want to. You will go with him if that helps…..

It sounds like you were able to talk to him. He was defensive but appreciative to know you care. In a moment when things are calm, talk with him again. Use the outline of how to make a request (Exercise 21 in Module 8) (the full eLearning program is available to our members) to help frame your talk. Leave out the talk of drugs. This is about his safety and you learning how to care for him.

 

Be aware of manipulative behavior

It is possible that your brother isn’t suicidal. His talk of not being around, etc. might instead be a way to gain your empathy or attention or needed handouts of money, etc. He has learned along that way that this is the quickest way to maneuver you to where he wants you.

The possibility of a drug overdose or running away does that same thing. It makes family members cross their own boundaries, whether it be by protecting the person from the potential of hurting themselves or by avoiding hard, angry or hurt feelings by giving them what they ask for. The loved one doesn’t even have to say a word. You are so worried about overdose or running away, you are stifled from acting in a way that best addresses the alcohol or drugs.

I’ve reprinted below some sound advice from Kate Thieda,* a psychotherapist and author of Loving Someone with Anxiety .

 

What to do when someone is threatening suicide as manipulation

  • Express concern for the person, but maintain your boundaries. Threatening suicide is very manipulative, and the other person is expecting you to yield to his demands. By saying, “I can tell you are really upset right now, and I want to help, but I will not [fill in the blank],” you are showing that you care, but are also not giving in.
  • Put the responsibility for living or dying back in the hands of the person who is threatening you. Say to the other person, “I don’t want you to have a relationship with me just because I am afraid of you dying and you think I can’t live without you. Our relationship should be based on mutual love and respect, not threats. I love you, but I can’t stop you from making this choice, even though I wish I could.”

Also…

  • Don’t argue with the other person about whether he is serious about dying. Assume all threats are serious, and act accordingly. If you argue the point, he may make an attempt just to prove you wrong.
  • Remember that contrary to what the other person is saying, you don’t have to prove anything. He may be saying, “If you loved me, you’d stop me from killing myself,” but the truth is, unless the core issues of what brought him to this place of wanting to end his life are addressed, giving in to his demands over and over again will not fix anything. You will still be angry, and the other person will still be vulnerable to wanting to self-harm again. The cycle will not break unless a trained professional steps in.

 

There are no easy answers

With the advent of strong opioids, every episode of getting high is potentially deadly. Losing your child to running away has the same effect.

As Thieda says, your best chance of ending this cycle is to get your loved one to accept to go to treatment. The drug and alcohol use should be seen as one core issue that must be addressed. If you’re on this site, the chances are good that things are serious and will not resolve without help. There are no shortcuts. You can’t have your loved one locked up, not for long anyway. What you can do is mapped out in the Learning Modules on our member site. If certain natural consequences seem too dangerous to try, then don’t try them. You are going to have to be the judge. There are probably dozens of little natural consequences that are safer….like not providing companionship in the moment, or a hug, or a warm loving smile.

 

Time and patience

I was at a parent support group last fall when a couple talked about there not being time to do all these things we talk about with CRAFT. Their daughter was in real danger, continuing to use heroin despite being put on methadone. They needed to act now to limit her independence somehow; to protect her from herself. The parents in the room were quiet for a moment, and then the facilitator spoke up:

“You may think this is the long way around, to make these changes in your behavior, you may not see how this can work in a timely way, but for how long has your daughter been using and what all have you tried to limit her use? Has it worked? Taking 8 weeks to gain these skills and approach your daughter differently is the shortest way to your goal, trust us, we’ve been where you are: ready to build fences around our loved ones to save them. Our loved ones jumped over those fences. You can’t control your way out of this.”

 

You can take smaller and safer steps

It appears some family members have stopped giving your brother money, without calamity. Finding a way to limit your brother’s access to your parents’ house when he is high would be important, especially because it also means he wouldn’t get to see his daughter. Asking him to respect your elderly parents by not showing up visibly high could be a start. Again, seeking counsel from a professional, who  can guide the family with the risk and the stance you should take, who can help you with how to communicate with your brother, and who can eventually assess your brother, is an important first step.

Yes, the family DOES have a role to play. Your stance, behavior, and choices DO make a difference. At Allies in Recovery we are absolutely convinced of this. “Tough love” is not a successful technique. Our learning platform is set up to help family members learn the techniques that will reduce conflict, build that bridge of communication, and be effective in guiding your loved one into treatment. Together we will move your loved one towards recovery. Learn more here.

* Source of Kate Thieda citation: (https://blogs.psychcentral.com/wellness/2011/11/manipulated-by-suicide-threats/)

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