How Can I Get My Loved One to Rehab?

Dear GoodTherapy.org,

My family and I are worried sick about my brother, who has a terrible opioid addiction and is spiraling closer to the end of his life every day. A bit of background: About four years ago, he lost his wife after she had a stroke. Only a few months after that, he was in a car accident and severely injured his back. He was prescribed narcotics and physical therapy to help with the pain. His mobility improved, and I think we all assumed that with his apparent recovery, he was ceasing or adjusting his prescription medication at the rate his doctor was advising. He still seemed a bit “out of it,” but we knew the loss of his wife was still fresh, so that didn’t raise any alarms for us about drug use. Add the trauma and shock of a car accident on top of that, plus managing pain and a compromised physical condition, and we were ready to explain away anything that seemed out of character for him.

My siblings and I checked on him frequently as he continued to withdraw. Again, we were completely sympathetic and only cared that he was safe and taking care of himself to the extent he was able. He had always been active and positive, but his wife was his whole world. It seemed reasonable to us that he would have a complete change of demeanor and behavior after she was gone, only exacerbated by his car accident. When he started becoming more forgetful, we attributed it to his grief. When he never showed interest in his hobbies (like golf and playing piano), we understood it might be difficult for him to find pleasure in them anymore. And when he seemed irritable or slept for what seemed like days on end, it seemed reasonable that even those symptoms could be linked to his depression.

Eventually, we found his fentanyl prescription in his medicine cabinet, but he insisted it was just the bottle of leftover pills. We believed him … until we started finding baggies and unmarked pillboxes of the same medication around the house. We urged him to find a therapist, and for a while it seemed like he was doing that and improving, but another sibling followed him one day and found he was trying to see other doctors for more narcotics.

That was only a few months ago. Since then, we’ve been removing all the pills we can find, begging him to stop, trying to make him see he is not well. We’ve done everything short of a dramatic intervention, and now he’s angry with us and we have no idea how to get him the help he needs. To an observer, he would seem functional, if depressed. To us, now that we know better, he clearly has an addiction and needs to be around people who will help him get better around the clock. I am convinced he should be in a residential treatment center, and am working on getting my family on board with that decision. Please advise us how to help my brother, and what we should know about compassionately getting him into a rehab facility as soon as possible. —A Lost Brother

Dear Lost Brother,

Goodness. What an ordeal you and your family (and brother) have been through! I can only imagine the stress and worry all of you have for him, and my heart goes out to him for his current predicament and tragic loss.

First, I’m going to suggest something counterintuitive (with an explanation to follow), which is: get help for yourself (and this applies to all family members). I believe addiction is a family condition, so chaotic and painful that it ripples with a painful impact on the entire family system. The more you and your family can find an outlet for the trauma and massive uncertainty you are experiencing, the more you may be able to make loving, conscious, and clear-headed choices about what to do (or not do) rather than act out of impulse or anger or terror. It does sound as if your brother and family are facing a traumatizing situation.

The benefits of family members of addicted people seeking their own help are manifold. For one, it’s a way of reducing shame for the addicted person, who does not feel so alone in experiencing feelings of overwhelm, isolation, and so forth—strong triggers to keep using. It may possibly lend a feeling of “This is a family problem, and we’re a team here,” which might foster unity rather than divisiveness (as in, “You have a problem and you are tearing us all apart”).

Second, it role models responsibility, taking charge of oneself. Focusing on your own emotional state rebalances the system, so that anxious attention does not “hover” over the minutiae of the addiction (Did he find the pills? Should we call his doctor?)—which does nothing but stoke anxiety and resentment anyway.

One of the grave traps well-intentioned family members fall into is allowing the addicted person’s behavior to “call the shots” or “steal the spotlight,” so that the addiction holds the entire family hostage. Addiction is a chaotic tyrant/bully, and it takes a village to fight it: with love, patience, and compassion, balanced by firm and consistent boundaries. Not at all easy to do, which is why finding one’s own support is crucial.

One of the grave traps well-intentioned family members fall into is allowing the addicted person’s behavior to “call the shots” or “steal the spotlight,” so that the addiction holds the entire family hostage. Addiction is a chaotic tyrant/bully, and it takes a village to fight it: with love, patience, and compassion, balanced by firm and consistent boundaries. Not at all easy to do, which is why finding one’s own support is crucial.

We want to have compassion but also dignify the addicted person’s right of choice and responsibility. There is a difference between saying, for instance, “You’re making us all worried sick, so why don’t you do something, already? Get help! Stop! Can’t you see what you’re doing to all of us?” as opposed to, “I am getting help, since this is so stressful for me. I see it is a serious family issue, not a weakness, and it helps me to get support. I love you and I fear you’re destroying yourself. Do you want to talk about this?” (Or something along those lines.)

The kind of help I am talking about here involves (for example) Al-Anon; a government-sponsored website on addiction that lists family options; the National Council on Alcoholism and Drug Dependence’s website for family members, and so on. There are therapists you can contact, too, who specialize in addictions, and specifically in working with family members. This last detail is crucial, since working with an addicted person versus their loved ones are two different things. A group such as Al-Anon can lend support and offer practical experience; a therapist or counselor can help you sort through options, cope with stress, or deal with your own frustrations and troubling emotions. (I lost a sister to this awful malady, so I know just how distressing all of this can be.)

There is also an extensive conversation/thread after one of my Dear GoodTherapy.org responses on the subject you might find useful. There are many practical and supportive posts by people who are going through the same trying experience.

Two other points. You say you have done everything “except a dramatic intervention.” At some point, you all may decide this is the next thing to try. People often ask me when an intervention seems “indicated” or appropriate. There is no clear, universal answer to this. As a rough generalization (without knowing all the specifics), I suggest interventions when everything else has not worked and the person appears to be in imminent danger, and—crucially—when the family has found an interventionist they trust and who understands the addicted person’s family dynamic.

A skilled interventionist works with the family rather than imposing a cookie-cutter approach. You’d want someone who can find the right treatment center for your brother’s needs, not one of the two places the interventionist has a “special relationship” with. (For instance, some rehabs are very AA-focused and some are not. Some treat the underlying issues of depression or trauma—in this case grief too, I surmise—and some say, “We’ll get to that later.”)

Strange as it is to say, the intervention is as much for the family as for the addicted person. The former gets to feel they truly have done everything possible, while the latter has a chance at sobriety. Again, it depends not only on your brother but the dynamic as a whole.

Finally, please know (1) you are not alone and (2) there is no “perfect” or “correct” way to handle this. In fact, the latter point often creates stress since it can be frustrating when sincere appeals to common sense or rationality go nowhere. I like to advise families to see themselves as fighting the addiction while loving the person, that the “bad” addiction is holding the “good” person hostage via fear and shame—and dishonesty. (Denial, dishonesty, and rationalization are very hard to crack in some cases; it goes with the territory, alas.) Sometimes it’s a matter of saying to the person, “I need to pull away now. I can’t stand by, keep loaning you money, and watch your addiction take you down; it’s too painful. But I’m here if you want to get treatment. I’ll also drive you to an AA meeting if you want to try that.” Sometimes it’s “What can I do to help, if anything?” or “I’m never giving up on you, no matter what.” It really depends, and there is no blueprint—only a series of difficult choices.

I wish you and your family and brother the very best of luck in facing such a painful problem and thank you for writing: itself a good sign as you are seeking input, a good example for your brother.

Kind regards,

Darren

Darren Haber

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.