“Get Me Out of Here!” Navigating Your Loved One’s Desire to Quit Treatment

Photo credit: Roman Ska

This Discussion Blog post is a little different: a response to member Nohp’s question by way of a recent episode on our Coming Up For Air podcast. Nohp’s husband has struggled with alcohol for over a decade. Recently, when faced with the possibility of divorce, he entered a 30-day residential treatment program—and he doesn’t care for it much. After two weeks, he wants out. Nohp understands some of his concerns, but worries that he will start drinking again if he leaves. Our Allies podcast team has a message for her: Discomfort does not mean treatment is a mistake. Allies’ writer Isabel Cooney elaborates.

It’s a very common phenomenon: in the first days and weeks of residential treatment, our Loved Ones may focus on what’s not meeting their expectations, and can often try to pass the “hot potato” of their discomfort to family members back home. The family begins second guessing everything, and efforts can quickly get derailed.

As family members, you are in a vulnerable place here—so much energy has been deployed in getting your Loved One into treatment, and now you may be holding your breath, wondering how it’s all going to turn out. And of course, you don’t want your Loved One to suffer.

Don’t let “the call” take you by surprise

Our podcast team addressed the issues brought up in the following comment from member Nohp—you can listen to the episode here. Spoiler alert: the main takeaway is Sit tight!

This post is a synopsis of that enlightening episode, which looks at the ubiquitous nature of discomfort when SUD is present, ways we inadvertently help our Loved Ones to exit uncomfortable situations, and techniques for passing the “hot potato” back to the person it belongs to. Here’s what Nohp wrote to Allies:

My husband is a 74-year-old, highly educated Chinese man who has had issues with alcohol for a long time. In 2011 he went into a 30-day treatment program and was abstinent for about six years after that. [Later] he started drinking again and got progressively worse. He has been in a very bad state off and on for the last couple of years.

I moved into my own place about six months ago. My lease was up for renewal, and I said I was going to renew it and file for divorce unless he went into treatment. I don’t know if this is setting boundaries on my part or being too coercive—but this seemed to be the only thing that would get him into any kind of treatment. He did go into a 30-day residential treatment program a week ago.

However, now that he is there, he has a lot of complaints about the place and wants to leave after two weeks. In some ways I can see his complaints. The program isn’t what was promised in several respects. There are only four other people there (there were supposed to be nine) and they are all in their mid-20s and unemployed. One of them refuses even to respond to my husband’s attempts at conversation. Not sure what is going on there. We were told that the clients tended to be professionals who were older. So, my husband says he is very lonely there and no one wants to talk to him.

They were supposed to have trips to local group settings like AA and Smart Recovery, but instead they just show videos of people talking about these groups. The counselors do seem good, however.

I don’t know how to respond to him. He says that he will go to one-on-one counseling and perhaps an intensive outpatient treatment program. I worry that he will go back to drinking again very soon if he isn’t in a residential program.

And here is my response to Nohp:

The situation you describe is truly challenging for various reasons. It’s also a common conundrum for anyone with a Loved One starting out in treatment. We thank you for bringing it up. Handling a Loved One’s response to residential treatment is a key task for the family member, and it’s essential to be prepared.

Expect some initial shock, uneasiness, and disillusion

Both the Loved One with SUD and their family members tend to have high hopes, and specific expectations, about how treatment will go. Often, significant amounts of money have been corralled, different options have been weighed, and your Loved One has been in very dark places. Everyone is hoping that this treatment episode will be the one and that their Loved One will get real traction in recovery.

The reality tends to be more complex. Your Loved One gets to a residential (or other) treatment program and may well go into shock, or what we might call buyer’s remorse. This is not what they expected. It’s awful, unbearable. The people aren’t the type of people they hoped to meet. The counselors are too strict, too this, too that. The housing is lousy. They can’t get cigarettes. They feel uncomfortable, disappointed, imprisoned. They want out.

Again, this is a very common phenomenon. So common that families should expect, and be prepared for, the call.

This isn’t what I thought it would be!

In defense of our antsy Loved Ones, residential treatment is often sold as some sort of camp or holiday—with yoga, hiking, amazing food, and people just like you who you’ll connect with. Quite often, there’s a real contrast between one’s expectations and the actual scene upon arrival.

Kayla Solomon, CRAFT-trained psychotherapist and Air podcast collaborator, points out that this phenomenon happens across the spectrum of various treatment types. Even with the highest-price-tag, most luxurious programs, families still get that, “This isn’t what I expected, this isn’t working” call from their Loved One.

“Truthfully, we don’t actually know what the reality is in there,” Kayla reminds us. But it’s fair to assume, “it’s not paradise.” And yet, she observes, there is always something to find—in every program, in every experience.

What are they getting?

Kayla encourages us to look at treatment like a meeting (AA or NA, for example)—which can often feel hit or miss. And that’s to be expected. “Even if you get one gem out of a meeting, it’s valuable. You’ve succeeded.” This day-by-day approach is the same basic idea as the “incremental progress” we seek to foster with CRAFT.

“Addiction, in general, is about trying to control stuff,” says Laurie MacDougall, CRAFT counselor, mother of a Loved One in recovery, and blogger for Allies. Substances often become a desperate attempt by our Loved Ones to gain a sense of control in their life. “Ironically,” she notes, “lots of what you’re learning in treatment will help you gain actual control over your life.”

These calls, and fantasies about leaving treatment, are nothing other than our Loved Ones “attempting to control how their recovery process goes,” suggests Laurie. “X was promised. X isn’t here. It’s another way to self-sabotage.”

Are we helping them avoid discomfort? Should we be?

Kayla insists that, in order to help our Loved One through this highly uncomfortable passage, “We need to look at our part in it all.” Historically, how have we helped them avoid doing what they need to do? How have we helped them reduce or remove the discomfort?

When your Loved One calls and—explicitly or not—asks you to support their leaving treatment, your tendency may be to do everything in your power to alleviate their discomfort.

And yet discomfort is the name of the game! It’s one of the factors that led them into substance use, it’s present throughout active addiction, and it’s equally present throughout recovery.

It’s ALL uncomfortable! (Yet we must push through)

“Sometimes we have to sit in discomfort to grow.”
Jonathan Van Ness

“As we know, the process of recovery—for all of us—requires doing the uncomfortable thing,” reminds Kayla. “All of us! Whether we’re a family member dealing with the Loved One or the Loved One dealing with their substances, it’s all uncomfortable. Getting off substances is uncomfortable. Changing your life is uncomfortable. Changing how you operate from day to day is uncomfortable.”

“It’s incredibly uncomfortable when we change our role and stop giving them help to exit the discomfort. It’s painful. They feel like we’re betraying them. Yet it’s not our responsibility.” Rather, she goes on, our responsibility is “to allow them to experience the program fully without one foot out the door.”

Kayla encourages families to pledge to stop facilitating our Loved One’s avoidance of discomfort. “If they decide to leave (treatment), it should be 100% on them.”

The stance: calm and confident (and get off the phone)

Laurie MacDougall knows how tough this stance can be. Getting that call, listening to your Loved One’s litany of all the “horrible” things they’re experiencing, is incredibly nerve-wracking. But Laurie encourages families to adopt a “confident stance” during such calls. The main message you need to send is, “You’re in the right place, you can do this.” After that, step back. Avoid getting into a full-blown conversation with them. “Maybe your Loved One learning to cope with discomfort is exactly what they need.”

In the podcast, Laurie shares the story of a series of “Get me out of here” calls she and her husband received from their son at the beginning of his first treatment episode in Florida. A counselor from the program, Bret, actually called to warn them to expect to hear from their son. He was spot on: they received the call a few days later.

“I didn’t understand at the time,” says Laurie. “But Bret explained that our son would surely call us, try to lure us into a deep conversation, and explain how horrible it was there. He said, ‘Your job as family members is to just get off the phone. Whenever he’s trying to pull you into a deep conversation, you talk about the weather.”

“I was a mess,” Laurie admits. “I was insecure about it. But we did what he asked us to do. And my Loved One did call, he did complain. And I would cut it short, talk about the weather. My goal became sending him one main message: You’re in the best possible place you can be in this particular moment.”

“He complained about one counselor, Bret. He’d fish around and ask me what I thought of Bret. ‘He seems like a good guy,’ I’d say. Ultimately, I came to understand that Bret was

getting the bad rap because he was the one holding [my son’s] feet to the fire. He was the one insisting on being rigorously honest. And [my son] didn’t like that, he didn’t want that. He had to face that.”

“In the end, when he left and moved to a recovery home, he had come to love Bret. They had an incredible relationship.”

What CRAFT suggests you do

Dominique Simon-Levine, founder of Allies in Recovery, reminds us that CRAFT asks us to revise our position, response, and strategy from moment to moment. And while we remain flexible and prepared to adjust our response to new behaviors, we’re always asked to pick a stance and stick to it.

In other words—unless you have some major, credible reason to believe the program is actually failing your Loved One—hold your stance 100%. Even if you’re not sure. Even if you may do it differently next time. Even if, when you hang up, you start researching other treatment options in case they do bail. The clearer your message is, the better your Loved One will be able to receive and reflect on that message.

“Be clear, simple, and forthright,” Dominique urges. “This isn’t the family member’s problem.” She suggests a basic statement that puts the onus back on your Loved One: “I’m sorry, I don’t really have an opinion on this,” or “I’m sorry, I don’t have anything to say about this.” All the while sending the clear message that they are:

• capable of working this out on their own,
• capable of staying put, and
• in the best possible place for now.

If they ultimately do decide to leave, she emphasizes, it’s vital that that decision be clearly, and solely, their own.

“My main mantra became, ‘I’m confident that this is where you need to be,’ even if I wasn’t 100% sure, even if I had some doubt,” Laurie shares.

In Summary

If and when you receive the call from a Loved One who’s discontented with their treatment program, Kayla Solomon urges you to “be careful about what you’re hearing.” Remember that there is always something of value in the program, and that your Loved One most likely has a history of avoiding discomfort.

She then offers a quick review of the takeaways:

• Regulate your own emotions.
• Discomfort is normal.
• Your Loved One will look for help to get out, but please hold the line.
• The message to be sending is, “You can manage this. It would be great if you could find something good and helpful about the program. I don’t want to be part of the decision.”
• Support their staying, not their going.

“It’s so destabilizing when they’re telling you how horrible it all is,” Kayla says in closing. “Restructure that story—and your own perceptions. In the end, it’s up to your Loved One to stay.”