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Resisting Treatment? He’s Not a Rare Case

Substance Use Disorder (SUD) typically occurs in stages — and readiness to seek treatment is not the first of these. In the case of Artprodigy’s son, that readiness has yet to arrive. The good news is that we can learn to spot and encourage the motivation our Loved Ones need to embrace treatment and recovery. The CRAFT skills we teach at Allies are the foundation for this approach.

We had to take our son to detox as he was unconscious. He did not want to go to detox. His wife insisted, and he eventually went in. Right now, after two days, he is upset about why he is there. His wife and his business partner would like to take him to rehab for one month right after he finishes detox. Would that work with him, when he did not even want to go to detox?

Welcome, Artprodigy. I am glad you found us. Your son was taken to a detoxification unit, unconscious. Had he been able to choose to go, he wouldn’t have gone. Safe to say your Loved One is what we call “treatment resistant.”

Resisting treatment is common with SUD

Even among those who admit to having a problem with alcohol or drugs, 50% do not want to be treated (Reasons for Not Seeking Treatment, National Library of Medicine, 2004). This is what the CRAFT approach was designed to address: resistance. It’s a huge issue across the world of substance use disorder, and is not limited to the person with the problem. We at Allies recognize that resistance also exists in the family of the person with addiction. Families often need motivation to roll up their sleeves and make changes in how they respond to their Loved One.

The quick answer to your question is that your son will need to decide for himself what follows discharge from the detox unit. You can use threats or leverage a Loved One into treatment, and you may need to. Taking your son unconscious to a detox unit fits this scenario. We encourage family members not to take changes. If your Loved One is unconscious and cannot be awakened, it is an emergency.

You cannot know for sure what caused them to become unconscious.  It is time (and opportunity) to get them help, as you did. Over the long run however, you are likely to find that this approach is limited and divisive. Learning to better understand what is going on with you concerning your Loved One’s drinking, and how to influence him, will move you both to a better place faster and with less friction.

The approach we take here at Allies was designed by researchers at the University of New Mexico back in the late 1990s, using all that we know about motivation, communication, behavior, and intervention. The skills we teach you directly address resistance, and reliably get about two-thirds of Loved Ones like your son to go to treatment under their own steam—not by mandating or threatening, but through kindness, positive talk, and effective behavior change on your part. “Your part,” by the way, is the part we work on here at Allies.

The next steps after detox

A 30-day residential program is indeed a good plan, as are plans that can be put together in the community, provided there is a home your Loved One can go to that is conducive to recovery. Both approaches are equally promising. The common argument against residential programs is that your Loved One will still need to return to his community, and like a newborn, splash down into normal life.

After the residency, there’s an urgent need to create a network in the community—therapist, psychiatrist, mutual aid groups—of the kind they’ve just left behind. It can be quite frustrating when you feel that urgency more than your Loved One (I recently worked with a mom in a similar situation. Her son ended up in the hospital with grand mal seizures and wanted to go nowhere but home after discharge. After 30 days at home, he had yet to pick up the phone, check out a meeting, or make a move towards supporting his tenuous hold on abstinence).

In your case, it sounds like your son’s job will let him take 30 days, since he is self-employed, and his partner agrees with and is even encouraging residential treatment. This is great news: many people would lose their job, or hurt their business, if they were absent 30 days.

Money and local environment

Employment is one factor in the treatment decision-making process post-detox. Another is money. Be very careful with insurance or treatment providers that promise to cover inpatient/residential care. Many of us have had nasty surprises. We are now offering help to locate treatment for our members (though we can’t give referrals). Let us know if you’d like this kind of support by clicking Contact Us on the home page.

It may also be important that your Loved One get out of their local environment for a time to get some traction with abstinence. This is the case if the home situation is not conducive to abstinence, or there is no home, or when the immediate environment (i.e., the neighborhood) is unsafe.

To compare what a community approach might look like for your son, may we suggest you read a couple of posts (including this blog post and this blog post) about having him at home with community supports and treatment? Here as well is our post describing the various types of treatment out there and their levels of intensity. You are also going to want to familiarize yourself with peer recovery support services in your area, typically provided through a community recovery center.

Learning to spot and encourage motivation for change

We’ve covered employment, money, and environment. One more key factor is your Loved One’s motivation. Here’s a brief primer on the subject. Expect motivation to come and go for your Loved One. It can look like ambiguity, which can look like lying — I do have a problem…I don’t have a problem; or I will go to treatment…I don’t need treatment.

Perhaps what you see in your Loved One just feels disingenuous. They behave like someone else. They have a different persona. You simply can’t trust that they will do what they say.

Perhaps, at times, they come out and talk frankly about their drinking or drug use. Then, clunk, the door slams tightly shut. “What do you mean I have a problem? I’m just fine” is the default mode.

We’re here to teach you about motivation—how to spot it, and how to tap into it. Your son is an adult. He can walk in or out of treatment at any time. Efforts to pressure, cajole, or beg for him to enter treatment may work this time, but are problematic. Perhaps your Loved One just hunkers down with his anger at you and is hard to reach in treatment. It really helps when they have both feet planted in treatment, ready in some degree to work on things.

Stages in the struggle

Let’s quickly review the three stages of addiction (covered in Module 1, Segment 2).

  1. Abandon
  2. Control
  3. Resolve

With abandon, your Loved One has no intention of stopping. It might be said that they use with abandon.

In Stage 2, control, they’ve noticed that taking a drug or a drink may be a problem, and start making changes to their behavior, like switching to wine from hard liquor or only doing cocaine on weekends. I like to think of these changes as small experiments in getting sober.

They often don’t work because the problem is actually bigger than they first realize, but these experiments provide critically important opportunities for learning about their addiction. With each successive failure comes a growing recognition that the problem is bigger and harder to resolve than they first thought.

Most people with addiction spend a majority of their time in this middle stage, trying and failing to control use. This is where I suspect your son has been recently. His thinking may feel chaotic as he flip-flops about his drinking, its importance, its pitfalls.

He may claim to be just fine when asked. But if you pay attention, you may catch glimpses of your Loved One trying to take baby steps to curb his use. Maybe he chooses beer over hard liquor, or doesn’t drink on a Sunday night in order to be in good shape for work on Monday.

The third stage is when they get that resolve and commit to stopping. Now they’re having periods of abstinence, eventually longer periods, with rarer and ever-briefer relapses, along with an emotional commitment to living a sober life.

Here’s how we might graph this process over time:

I’ll stop here. There is so much to say, but these fundamental points are a good place for you to start. I hope this post helps orient you regarding your son’s addiction to alcohol. This program is designed to fully empower you to help your Loved One resolve addiction, and also to radically improve your own feelings and confidence so that you move in the direction that has the best chance of succeeding.

Again, welcome to the site. We are here to hold and support you going forward.

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