I don’t like to admit it, but it’s true: generally speaking, women can’t handle their liquor as well as men. Although there are always exceptions, research indicates women are more sensitive to the effects of alcohol. More specifically, it hits them harder and faster.

One of the main differences between men and women related to drinking has to do with dehydrogenase, a metabolizing enzyme that helps the body get alcohol out of its system. This enzyme helps men process alcohol more efficiently, allowing them to drink more and not feel the effects as quickly. Women generally have less of the enzyme than men, so more of what women drink enters their bloodstream as pure alcohol.

Women tend to weigh less than men, and on average, women’s bodies contain less water and more fatty tissue than men’s. Because fat retains alcohol while water has a diluting effect, alcohol remains at higher concentrations for longer durations in a woman’s body, exposing her brain and other organs to more alcohol.

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It would seem feeling the effects faster simply leads to not being able to drink as much as quickly. However, a dangerous biological factor comes into play for females.

Females are at greater risk than males for developing serious alcohol-related physical problems. Once a drink is consumed, it goes through the digestive tract where it is dispersed through water in the body. The more water that is available, the more diluted the alcohol gets. Again, on average, women weigh less than men. As a result, women’s bodies are more exposed to the toxic byproducts the body releases when it breaks down alcohol. Thus, a female is at significantly higher risk for developing organ damage such as alcoholic hepatitis and cirrhosis. Females are also more likely than males to die from these conditions.

But the potential damage does not stop at the liver. Because women’s bodies are more exposed to alcohol’s toxins, they are more likely to experience alcohol-related brain damage and loss of cognitive function. Women who drink heavily also have an increased risk of thinning bones, falls and hip fractures, infertility and miscarriage, premature menopause, high blood pressure, heart disease, and cancer, especially of the breast, head, and neck.

While men have higher rates of alcohol use disorder diagnoses, women experience the physical damage from drinking significantly more quickly than men do. Consider a man and a woman who both drink heavily. Over time, statistically, the woman will begin to have more severe health problems within five years, while it may take 20 years for the same health issues to show in a man.

Another biological factor that affects the sexes differently is hormones. The fluctuations in hormone levels during a woman’s menstrual cycle may affect how she metabolizes alcohol. The intoxicating effects of alcohol will set in faster when a female’s estrogen levels are higher. This typically occurs just before her period.

These biological factors explain why women may become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities for fewer years than men.

Alcohol, in a cruel turn, increases estrogen levels. A woman taking estrogen-added birth control pills will become intoxicated faster and stay that way longer. The medication slows the rate at which the body eliminates alcohol. Her hangover may also be worse than a male counterpart’s. These biological factors explain why women may become intoxicated after drinking less and are more likely to suffer adverse consequences after drinking smaller quantities for fewer years than men.

As my previous article reported, while drinking, men tend to experience more impairment in judgment than women do. And as noted above, a woman is likely to feel alcohol’s effects more quickly and for a longer period. These two biological realities can lead to a dangerous outcome: sexual assault. Each year, one in 20 women is sexually assaulted. Research confirms there is an increased risk when both the attacker and the victim consume alcohol prior to the assault.

A final way in which alcohol affects the genders differently is in seeking help. While the stigma of women drinking may be decreasing, there still appears to be stigma around getting help. Women are more likely to attribute their problems to depression, anxiety, or family troubles rather than drinking. This creates a ticking time bomb of sorts. Behavioral health care providers must be trained to look beneath the presenting issue and help women see the first step may be to address the alcohol use. Once the drinking is under control, other issues may be more easily recognized and resolved.

Conclusion

Due to biological differences, women, on average, experience the effects of alcohol use in different ways than men. Weight, body fat, enzymes, and hormones are all factors that increase the likelihood a woman will experience physical problems related to drinking more quickly than a typical male.

By remaining aware of their respective risk factors, women and men alike may make more educated decisions regarding drinking and ward off potential consequences.

References:

1. B.R.A.D. (2013). Women and Alcohol. Retrieved from http://www.brad21.org
2. Centers for Disease Control and Prevention. (2016). Fact Sheets – Excessive Alcohol Use and Risks to Women’s Health. Atlanta, GA: CDC.
3. Connery, H. S. (2011). Alcohol Use and Abuse – Harvard Medical School Special Health Report.
4. National Institutes of Health: The Office of Research on Women’s Health, Office of the Director, and the National Institute on Alcohol Abuse and Alcoholism. (2015). Alcohol: a Women’s Health Issue. NIH Publication No. 15–4956.

Do any of these statements sound like you?

• I find I am drinking more often
• Friends and family are starting to express their concerns about how much I drink
• More and more of the things I do involve alcohol
• Sometimes I drink more than I planned
• Getting a buzz is how I deal with stress, end the day, or have fun

If you identified with more of these statements than you would like to admit, it’s time to change your relationship with alcohol. According to the Dietary Guidelines for Americans, moderate alcohol consumption is having up to one drink per day for women and up to two drinks per day for men. The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends up to four alcoholic drinks for men and three for women in any single day, with a maximum of 14 drinks for men and seven for women per week.

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I recommend the Dietary Guidelines’ amounts over NIAAA’s. Many people start to feel an effect after two or three drinks. Then they have a harder time sticking to their limits because their decision-making is getting altered. I also recommend against drinking every day. It can become a habit and the way you deal with difficult emotions.

Most of the people I see in my work have experienced consequences from their drinking but are not physically dependent on it. They have tried those meetings for people who want to quit, but they don’t quite fit in. They know they need to change their relationship with alcohol, but they do not want to totally give it up.

So I did the research. Then I designed the “How Do I Know If I Can Keep Drinking Quiz” to help figure out if moderation is an option.

Answer yes or no to the following:

1. Do I have any mental health, medical, or legal concerns?
2. Can I pick someone who will support my moderation plan?
3. Have I had more than one blackout?
4. Am I willing to monitor how many drinks I have?
5. Have I had withdrawals from drinking?
6. Am I free of illicit drugs?
7. Am I drinking to change how I feel?
8. Will my loved ones support moderation?
9. Do the consequences of drinking outweigh the benefits of abstinence?

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use.

In my experience, answering yes to the even-numbered questions increases the chances of successful moderation. If you answered yes to any of the odd questions, you may not be a candidate for moderate drinking.

Below are some tips on how to try moderation:

• Identify someone who knows what your plan is and be accountable to that person.
• Plan an activity where alcohol is not involved. You may wake up feeling better the next morning.
• Have a response prepared for when people ask why you are changing your drinking patterns.
• Plan ahead what and how many you will have.
• Chose a non-alcoholic drink you enjoy and alternate it with the alcoholic one.
• Try a “mocktail”—a drink without alcohol. You may even save some calories!
• Order a tonic and lime. No one will know if there is any gin or vodka in your beverage.

Trying to change your drinking can be challenging to do on your own. If you are wondering if you have a problem with alcohol, find a licensed therapist who is trained in both mental health and substance use. Make sure the person you choose to work with is familiar with the concept of moderate drinking.

Together with your chosen professional, you can decide what a healthy relationship with alcohol looks like for you. It may mean quitting. But it also may be changing the amount and frequency of your drinking.

References:

1. Hester, R. K., Delaney, H. D., & Campbell, W. (2011). ModerateDrinking.com and Moderation Management: Outcomes of a Randomized Clinical Trial with Non-Dependent Problem Drinkers. Journal of Counseling and Psychology, 4, 215-224.
2. Logan, D. E., & Marlatt, G. A. (2010). Harm reduction therapy: a practice-friendly review of research. Journal of Clinical Psychology, 66, 201–214.
3. National Institute on Alcohol Abuse and Alcoholism. (1992, April). Alcohol Alert: Moderate Drinking. Retrieved from https://pubs.niaaa.nih.gov/publications/aa16.htm
4. U.S. Department of Health and Human Services and U.S. Department of Agriculture. (2015, December). 2015–2020 Dietary Guidelines for Americans, 8th Ed. Retrieved from https://health.gov/dietaryguidelines/2015/guidelines/

Dear GoodTherapy.org,

First of all, my partner does not hit, abuse, or commit any acts of violence toward me. It’s the main reason I haven’t left yet. I’m writing because I’m curious whether addiction alone is a valid justification for leaving.

I’ve heard of the “three A’s” (abuse, addiction, and affairs) that are warning signs and signals a relationship is in trouble. And I know everyone probably thinks their case is special, or that their lover is different than anyone else who abuses, cheats, or develops an addiction. I am aware the cards are stacked against me. So how does an optimistic person weigh all of those “givens” and make a choice about the future of a relationship?

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I have so much hope that my boyfriend will realize one day soon the strain his alcoholism puts on his health, our finances, and the plans we make. I catch glimpses of this realization occasionally when he sobers up (briefly). He has agreed to get help once or twice, but it never lasts. We’ve known each other for over a decade, and I loved the person I met all those years ago! I’m exhausted and sick of being the one person to try to remind him who he was.

Am I foolish for holding out hope that he will one day be that person again? Is there a chance I could get him the help he needs? —Hoping Against Hope

Submit Your Own Question to a Therapist

Dear Hoping,

Thank you for writing, and I’m sorry you’re in such a difficult situation.

The short answer to your first question (is addiction a valid reason for leaving?) is yes, with this caveat: it’s not so much the “addiction,” per se, but your boyfriend’s “straining” behavior (as you put it) while under the influence.

Your excellent question also signals one of the reasons living with an addicted partner is difficult: the dual nature of the person’s personality (sober versus not sober). It’s like living with two people, but only you know it. When something this distressing is unacknowledged, a person can start to feel like they’re losing their mind. This lack of acknowledgment of your experience creates a sense of isolation that is itself is a form of abuse, where “crazy” starts to feel normalized or we become numb to it—until it grabs our attention again and we ask ourselves, “Why the hell do I put up with this?”

Except it’s hard to say “get lost” to the sober version of the person we care about. That version may show remorse, contrition, regret, etc., a stark contrast to the non-sober version’s selfish, mean, and spiteful behavior. Episodes of the latter are often forgotten or downplayed by the sober version, perhaps accompanied by an apology that rings rather hollow.

You have an extremely difficult decision to make, and for that you may need support. You can look for Al-Anon meetings—highly recommended—near you by doing an internet search. There are also online support groups, books on living with an addicted partner, and so on. There are also highly trained and skilled counselors and therapists who specialize in addiction and living with an addicted partner. I urge you to get support before you make any big decisions.

Some prefer meetings to therapy; with others it’s the other way around. I find that a combination of therapy and meetings can be most helpful. In meetings, we find others who can relate to us, to cut down on that soul-wrenching isolation, shame, and other pain.

Addiction puts everyone, including the addicted person, in a no-win situation. Just as someone with alcoholism can’t seem to live with or without the bottle, you love your boyfriend but can’t live with or without him. Leaving and staying are difficult.

Addiction puts everyone, including the addicted person, in a no-win situation. Just as someone with alcoholism can’t seem to live with or without the bottle, you love your boyfriend but can’t live with or without him. Leaving and staying are difficult. There is no “right thing to do,” necessarily. Even partners who are physically abused (men included) can find it terribly difficult to leave; it is hard to leave someone we love, especially if we have a history of tolerating emotional abuse, relational chaos, or trauma. (We often cannot help being attracted to what is familiar.)

You would not be shamefully “dumb” to stay, nor shamefully “selfish” to leave. In fact, sometimes it is such a gamble that jars the addicted person back to reality. It is usually action, not just talk, that gets a partner’s attention.

Some might suggest it’s important to have compassion for the addicted person, and I would agree—to a point. Have compassion, yes, but also set boundaries against hurtful behavior you have nothing to do with and cannot influence.

A good therapist can help you do the painful work of taking care of yourself. We can feel guilty or neglectful if we set boundaries and look after ourselves, especially when an addicted person under the influence lashes out at us for “ignoring” them. But as with a child in tantrum, consistent and firm limits are important.

My usual advice to people in your situation—barring anything life-threatening or physically injurious—is to take very small but manageable baby steps. For instance, telling your partner (while he’s sober), in as neutral a way as possible, what behaviors are hurtful to you, and what you can and cannot tolerate. Start small. Example: “I need to talk to you. Is this a good time?” If not, “When is good? Tonight at dinner?” Then, at the right time: “I don’t mean to criticize, and this is a little hard to say, but please stop lashing out at me late at night. It really hurts.” You might add, if the hint is not obvious enough, “You seem more angry and attacking when you drink.” Again, try to stay with a neutral tone with a focus on your own pain rather than your partner. Other-focused comments such as, “Boy, you’re one angry drunk,” or, “When are you going to stop drinking like a fish?” are unlikely to lead in a positive direction.

One can argue facts, but not feelings. If a partner is unwilling to listen to feelings, consistently stonewalls, or becomes defensive, then the relationship is in trouble—addictive behavior or no addictive behavior.

If your partner says, “Well, you hurt me too! Stop being so critical!” you can say, “Okay, I’m willing to hear feedback too. Can we both agree to do some work on this together?” If you are both struggling with this, relationship counseling can greatly help. The point is to work toward peace and productive communication, not the same old cycle over and over again. Some people reading this might say, “Why is it up to me? I’m not the addicted person here.” To which I would say, quoting Al-Anon, “Do you want to be right? Or do you want to feel safer and happier in your relationship?”

If these conversations go nowhere, and if efforts to get outside help fail, then perhaps leaving becomes the only realistic option. Again, sending a firm message—I cannot tolerate such hurtful behavior—is crucial. Though difficult, making such a decision may do wonders for your self-esteem and sense of empowerment. It may also trigger sadness or grief.

I wish you the best of luck, and again reiterate that you are not alone. Please seek support. Admitting a need for help—for you or for a loved one you can’t seem to get through to—is often the bravest thing a person can do.

Kind regards,

Darren

First, thanks for writing. Second, I’m sorry to hear about your travails; I can only imagine the exhausting and frightening roller-coaster you have been riding. Finally, this may or may not surprise you, but even as a therapist I can relate to your question, “What kind of therapy is best?” I recently read an article by a newly licensed and overwhelmed therapist who said there are something like 200-plus “modalities” for therapists to choose from. It seems every other day someone is inventing a new approach to this, that, and the other. One research study says this approach is solid, the next one says the opposite. No wonder you’re confused!

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Fortunately, clarity can be found, because ultimately any good therapist—in my experience—is there to answer the question, “What is most helpful or healing for this particular person at this particular time?” Nearly all research studies come to the common conclusion that a safe and trusting therapeutic relationship is central to a helpful treatment. If someone has a viscerally strong response for or against one of my recommendations, my job is not to call this “resistance” but rather to listen, explore, and learn what’s going on.

So, point one: Is the therapist you’re talking to listening to you, as an individual, not a generic “anxious client” or “parent of an addicted child,” etc.?

In general, human beings prefer certainty to ambiguity, but offering too much certainty as a therapist is misleading and maybe even unethical. No one has a “lock” on what to do for sure. Now, practical suggestions can be helpful and reassuring. A common “tip” a therapist might offer someone in your situation might be to attend Al-Anon meetings. It certainly couldn’t hurt to try the program. There is much to be gained, even if it ultimately isn’t a good fit. (I’ll return to Al-Anon in a minute.) Other suggestions, such as “Take care of yourself” or “Don’t enable the addicted person” or “Detach with love” are a little more problematic, because although they might sound good, but what do they mean for you and your loved one, in this particular case, with whatever circumstances are happening at that time?

What if a person grew up in a family where setting certain types of boundaries, or stating one’s needs or limitations, drew traumatizing emotional fire? Are they being weak for not “speaking up” or “asserting their needs”? Trauma tells us something is still prohibited or dangerous, in the present, since we are wired for self-protection and safety above all. This is where self-help gives way to psychology, to empathic understanding and exploration of a person’s experiences, beliefs, and needs. Some parents may tell me, “Not giving my addicted child money feels like I’m killing them.” It would be easy for me to wave this off and urge them to withhold—“Hey, it’s for their own good”—but, again, that might be overly simplistic.

I would certainly recommend that you seek a therapist who has experience working with families and parents of addicted children, someone who can empathize and offer suggestions that make sense for you and your circumstances. A sense of safety and trust is essential.

I would certainly recommend that you seek a therapist who has experience working with families and parents of addicted children, someone who can empathize and offer suggestions that make sense for you and your circumstances. A sense of safety and trust is essential. One litmus test is, can you give the therapist feedback on what is or isn’t helpful and how does the therapist handle it? If they become defensive or claim it’s all your “resistance,” I say move on sooner rather than later.

Other factors you’ll want to look for: experience with addiction as it affects families; knowledge of treatment options (including local or community support groups besides or in addition to Al-Anon, and an understanding of Al-Anon, come to think of it!); and a patient but persistent curiosity about your experience. If it seems like a lot to ask, it may be; but to be honest, so what? Addiction is a merciless, complicated issue (some prefer to say “disease,” others don’t); it takes a lot from people and asks a lot from families, so it stands to reason people in therapy will, at least some of the time, need a lot from their therapists. It comes with the territory.

I also suggest you try at least two or three therapists to get a sense of different styles and so forth. This is not uncommon, and it makes a lot of sense.

Finally, a word on Al-Anon. Some swear by it, others say “stay away at all costs.” I think any rigid position is potentially harmful. I think trying it is a good idea. (It is also good role modeling for your child, who may not be so keen on attending meetings at first but may ultimately find them essential.) Try a few different meetings; attending one and disliking it is common, but no two meetings are the same and some fit better than others. Some are turned off by the spiritual talk, others aren’t. I suggest you take what you like and leave the rest. At the least, it allows people in your position to share their experience in a communal setting, offer practical ideas on what has worked and what hasn’t, and may possibly provide support for those, like you, who are overwhelmed and beleaguered. Addiction is a hurricane, and everyone in its path suffers.

I think it is terrific that you are seeking support. That shows a humility and inner wisdom that should be nurtured and supported by the right provider. Sometimes, what people need most is a sense of hope. There is no shame in seeking or wanting this. Yes, sugarcoating or fantasy can be dangerous, but so can hard-edged “realism,” since the truth is we just don’t know what will happen from one day to the next. It is a day at a time for all of us, therapists included.

Thank you for writing, and best of luck to you in your search.

Kind regards,
Darren

There are many different types of residential treatment centers (RTCs) that offer therapeutic care for a wide variety of behavioral and mental health issues. Choosing a center that is suited to your personal needs is important; however, with many options available, making a decision may be difficult. How can you decide which RTC is right for you? Consider these answers to ten frequently asked questions about RTCs, as well as insight from Darren Haber, MA, MFT, an expert on addictions and compulsions.

1. What is a residential treatment center?

A residential treatment center is a health care facility that helps people experiencing various substance dependency and behavioral issues. For some inpatient treatments, residents may be required to live at the facility for a period of time. Some facilities also offer outpatient treatment to help former residents avoid relapse and to provide options for people who cannot commit to living at the facility temporarily. In most cases, treatment lasts for one to three months.

“[The] average stays tend to be 30 days, but some stay longer, and some shorter. Thirty days seems to be the industry norm,” Haber said.

2. What are the most important things to look for in an RTC?

Check and confirm that the RTC and any programs you wish to attend are accredited and the treatment programs are being administered by licensed, qualified mental health professionals. Ask if the program has a clinical director and about his or her credentials. Learn as much as you can about the treatment center you’re considering through third parties such as the Better Business Bureau, online reviews, and any local consumer protection agencies. If you need it, ensure that an active aftercare program is in place to help prevent relapse.

3. What type of issues do residential treatment centers treat?

Because different RTCs specialize in treating different health issues, the structure, routines, and therapeutic methods used will vary from facility to facility. Some centers take a “lock-down” approach where residents are secured within the facility’s premises and their movements inside the center are restricted. Other RTCs may take an unlocked approach and allow residents to traverse the premises with some degree of freedom; however, residents may only be permitted to leave the center if certain conditions are met.

In recent years, the residential treatment field has expanded. At some centers, everything from substance abuse to sex addiction to codependence may be treated. There are also centers that focus solely on substance abuse or eating disorders, for example.

Issues treated at an RTC may include:

• [rtc_widget_right]Drug dependency
• Alcohol dependency
• Eating disorders
• Sexual addiction
• Bipolar
• Depression
• Posttraumatic stress
• Personality issues
• Anxiety

It should be noted, too, that some RTCs specializing in mental health treatment may not provide therapeutic care for substance dependency issues.

4. Why do people go to residential treatment centers?

“Usually because their condition or problem has reached the point where it needs containment—that is, 24-hour medical or psychological monitoring due to harmful behaviors or medical problems—and has become so acute that it requires an acute, sustained focus,” Haber said.

5. What kinds of services are provided by RTCs?

Residential treatment centers offer a variety of services, which may include 24-hour supervision, intensive recovery programs, individual counseling, group counseling, structured activities, educational services, social skills training, vocational training, and relapse prevention services.

6. What are the benefits of a RTC over other forms of treatment?

The environment in a residential treatment center is usually more comfortable than the sterile, functional setting of a hospital. The residents are able to focus solely on their healing and recovery programs as they are removed from the stresses of daily life.

Some treatments, such as chemical detoxification, may be life threatening. For those cases, RTCs provide trained medical personal to keep residents safe during such treatments. Residents also have the opportunity to explore the emotional and psychological underpinnings for their behaviors in counseling sessions with a qualified mental health professional.

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened,” Haber said.

7. What is the experience of being a resident at a residential treatment center like?

“It’s really what the client or patient makes of it. Anyone who participates to the best of his or her ability can potentially gain much and grow and learn tools for lifelong use. If one has been forced in by family but doesn’t believe, for instance, that one truly has an issue with alcohol or addiction, it can feel almost like jail,” Haber said.

8. How can families or friends keep in touch with residents?

“It depends on the policy of the residential treatment center. Some encourage family contact and some don’t. Some RTCs prefer those in treatment wait until their detox is over, or that the person in treatment only meet family members with counselors present. I believe this is a crucial part of treatment that can easily be overlooked, since dysfunctional family systems often play a crucial role in the formation of the illness or addiction,” Haber said.

9. Are there any RTCs in my area?

With the number of treatment facilities currently providing care across the country, chances are there is a residential treatment center nearby. However, it is important to remember that your chances of recovery may be better if the chosen facility is well suited to your personal preferences and specific health condition.

10. How much does treatment at a residential treatment center cost?

“Some people also go for legal reasons, such as being ordered by a judge after a DUI or DWI, for example. Usually one goes to an RTC because living life day-to-day has become unmanageable or to the point where one’s well-being, job, or close relationships are threatened.”The cost of treatment at a residential treatment center will vary based on the condition being treated, services provided, length of treatment, and the location of the center. For example, The Betty Ford Center, one of the most well-known rehab programs, charges approximately $1,217 per day for inpatient alcohol addiction treatment at their Rancho Mirage, CA location. Other locations may charge more or less, and some may not offer a per-day rate. Most locations develop a program based on a person’s individual needs, which can drastically affect the cost depending on medication or other requirements.

Some facilities may be able to offer a sliding fee based on a person’s income, while some may be low or no cost. Others may offer luxurious settings and amenities. The types and costs of RTCs simply vary. If your personal health insurance covers residential care, even the more costly facilities may become affordable. Call your insurance company for more information regarding your covered benefits if you are in need of inpatient treatment.

References:

1. The Addiction Recovery Guide. (2015). Drug and alcohol addiction recovery. Retrieved from http://www.addictionrecoveryguide.org/treatment/residential
2. The American Residential Treatment Association. (n.d.). Types of programs. Retrieved from http://artausa.org/type_programs.html
3. Federal Trade Commission. (n.d.) Residential treatment programs for teens. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
4. Hazelden Betty Ford Foundation. (n.d.) Addiction treatment specialties. Retrieved from http://www.hazeldenbettyford.org/treatment/locations/betty-ford-center-rancho-mirage
5. Mental Health America. (n.d.). In patient care. Retrieved from http://www.mentalhealthamerica.net/patient-care
6. National Institute on Drug Abuse. (n.d.) Principles of drug addiction treatment: a research based guide. Retrieved from http://www.consumer.ftc.gov/articles/0185-residential-treatment-programs-teens
7. Smith, M., & Segal, J. (2015). Choosing a drug treatment program: What to look for in substance abuse rehab. Retrieved from http://www.helpguide.org/articles/addiction/choosing-a-drug-treatment-program.htm

I hear your love and concern for your sister. There is nothing more painful than watching someone you love make choices you believe are harmful. Unfortunately, they are her choices. You will not get anywhere with your sister if you lecture her about the choices she is making. Letting her know (directly or indirectly) you think her boyfriend is a “loser” will most likely only serve to distance her from you and strengthen her bond to him. It also makes it less likely she would confide in you if she did have misgivings about her relationship or her choices; nobody wants to hear “I told you so” from anyone, particularly family.

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At 19, your sister is technically an adult. You characterize her behavior as stubborn. That feeling may be contributing to a dynamic that makes her believe you and your parents don’t respect her, don’t see her as a capable adult, and don’t understand her needs. Given that dynamic, of course she isn’t going to listen to you. She may insist on sticking to her (destructive) choices just to prove her independence. As long as you continue to approach her with opposition, little is likely to improve. Also, even if you were successful in “getting rid” of the boyfriend, that is no guarantee her life choices would improve.

May I suggest you reach out to her from a different place? Listen to her. Find out from her what works for her in her relationship. What draws her to her boyfriend?

May I suggest you reach out to her from a different place? Listen to her. Find out from her what works for her in her relationship. What draws her to her boyfriend? Let her know you aren’t trying to “meddle”; you are just trying to understand her choices. Lead from a place of love and compassion, not judgment and fear. You can also ask her if she’d be willing to engage in family therapy with you and your parents to see about changing your family dynamic, independent of the boyfriend.

The drug use is absolutely a concern. Not only are there potential physical, financial, and legal ramifications for what she is doing, but emotionally, it is likely distancing her more from you and your parents and connecting her more to her boyfriend as well as impacting her ability to make effective choices. Working with a family therapist and an addiction specialist (with or without your sister) can help you identify some effective intervention strategies. Attending a Nar-Anon meeting could also shed some light (again, with or without your sister).

Best of luck,
Erika

Thank you for your question, which sounds like just about every parent’s nightmare—one that’s more common than you might think.

For me, the key to the answer is in your last two questions. You seem to assume that you did something “wrong,” leading to feelings of guilt, shame, anger (at yourselves or each other and/or your son), and say you want to get your son “back.” I assume you mean the way he was before he took on the appearance of a “rebel” from a bad 1950s movie.

He is still the kid you love, still good—just struggling with something beneath all of that strange and troubling behavior. I would hesitate to conclude he is definitely “ruining his life” because I would bet, in the larger context of his life, his behavior probably makes some sense. Most teens go through a rebellious phase, whose aim in part is to annoy or even frighten the living hell out of parents. So I wouldn’t take the bait completely. Of course this is very concerning and needs to be investigated, and consequences are crucial (provided they are communicated clearly and enforced consistently), but something tells me “tough love” or drawing a line in the sand may only alienate him. The trick is reaching to connect with the kid behind all this behavior (fighting, smoking) that also keeps his teenage need for individuation and autonomy in mind. Not the easiest relational dance by any means, which is why the teen years can be very difficult indeed, and why a good school counselor or family therapist can help.

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Seeing this as a family problem, not his problem or your problem, is key. Drawing in teachers and school counselors is good, as is including the parents of the other “troublemakers” he runs with. Something is attracting him to this crowd; what is it?

And again, what was happening before? Was he a good student? Fortunately, this is all happening now more or less under your roof, which tells me this is in part a communication to you—a rebellious, perhaps angry communication at that. As if he’s saying, “I’m making my own rules, got it?” But what might be happening in the family dynamic such that he feels compelled to “say” and do these things? And why isn’t he fearful of consequences? The compulsion to do these things, which includes numbing or distancing from certain thoughts and feelings, means whatever feelings he’s pushing away and expressing via behavior are more powerful than the fear of going off track in school and developing “shady” friends.

Why might he identify with these friends, incidentally? Try to really put yourself in his shoes and forget black/white, right-and-wrong thinking. The harder you push for “the right side” of the line, the more he’ll likely stand on the other side and dig in. Welcome to the teen years. But keep in mind this may be the only way he knows how to express whatever is happening inside him, probably inexpressible.

Of course your concerns are understandable, given his behavior at school and his alarming drug/alcohol use. Yes, many teens experiment with booze and pot, but in this case 15 is pretty early for him to be using it in such a casual way (as opposed to sneaking a beer or joint with friends at a concert). Again, it’s as if he wants you to know about it, as it’s happening, right under your nose.

In some cases, children have tried to be “good” for so long that this goodness becomes a burden, often privately felt, leading to a swing in the opposite direction. Or there’s an anxiety or hurt that drugs and booze cover up. Could your son find some rebellious expression in arenas besides pot—such as music, drama, filmmaking, sports, etc.? Something assertively geeky or super cool where he can stand out and feel good about himself? Teens want to be cool and feel cool, in all ways, be it computer programming or punk rock. These other kids he hangs with make him feel cool, though I wonder why he has embraced this particular incarnation. Of course, many of our greatest innovators were rebels; the challenge is finding an outlet that is free from self-destruction and liberates/transcends rather than medicates the difficult emotions of adolescence. (It’s difficult for parents, too!) It’s likely that underneath all this tough-guy stuff is fear and/or anxiety. It sounds like you may be anxious also, which is why you need to be a role model of calm. Anxiety is contagious throughout a family “system.”

It’s good that he wants to feel cool and have friends; what’s not cool is that his current behavior will lead him nowhere positive in the long run.

Has your son demonstrated an interest in anything previously that might provide for his self-expression? Anything creative rather than destructive? Can you or a counselor or teacher help him find such a direction? Anything that can “hook” his interest can help him find a way back into engagement with school, such as a magnet school for music or technology, for instance. Volunteer work, too. Karate. Photography. Fly fishing. Think outside the box; offer him incentives for trying something new. Maybe his dad or grandpa or someone could even try doing it with him for the first time or two. I’d bet he has an untapped passion.

You and your husband ought to decide, first, what is and isn’t acceptable to you both. Make sure you’re both on the same page. The calmer you are in general, the safer he’ll feel bringing his troubles to you. I recommend tough love if and after the other ideas flop.

And now, consequences. I imagine you have leverage, since he’s 15 and, I’m presuming, approaching driving age. He’ll want driving lessons, need car insurance, and so on. Here’s where you get to be loving but firm parents and decide what is and isn’t acceptable. Anything less than a “B” average, for example, means no driving. Missing a curfew means no car (and possibly phone) for the next __ days. Drinking and driving means no car keys for the next __ months, minimum, and the loss of other privileges (social media, etc.).

You and your husband ought to decide, first, what is and isn’t acceptable to you both. Make sure you’re both on the same page. The calmer you are in general, the safer he’ll feel bringing his troubles to you. I recommend tough love if and after the other ideas flop.

Usually a child his age struggles with developmental challenges. He may not be completely comfortable talking to you about them, which isn’t your fault. Is there a school counselor or teacher who can get involved? What do these folks, probably seasoned observers of teens, think might be happening? What about the parents of his pals?

Does your son have an uncle or grandpa, some adult he trusts, who can spend some time with him and help him open up about what’s going on? Can they go to a movie or a ballgame? It takes a village, as they say, and parents are often the wrong messengers for the right message because of the rebellion factor. Also, children need to complain and gripe about their folks a bit; sometimes “delinquency” is a kind of grandiose, covered-up lament or expression of hurt feelings that they feel can’t be expressed any other way.

What do the parents of these “bad influences” have to say? The more communication among all of you, the better. You need to know where your son is, within reason, and to let him and his friends know that caring eyes are watching.

Also, what is your own attitude toward drinking and drug use (including pills)? That may have some bearing on your son, if you or your husband tip too far toward rigidity or looseness; at any rate, his drinking and smoking is a symptom of something deeper, but neither is helpful to his development if overdone.

It would be interesting to reflect upon how and when the “old version” of your son changed, and what may have been going on in the overall context of his life. We all change. But was there any big change? New neighborhood, new school, the loss of a girlfriend? If he is self-medicating with drugs and alcohol, why? What might be causing anxiety, worry, or other troublesome feelings? Is he worried about dating, college, becoming a man? I think it is important to remember he is still the boy you love, struggling as manhood fast approaches. It’s a confusing world, and teens are bombarded with all kinds of conflicting messages. Personal identity questions around freedom, autonomy, and self-expression are all being worked out, often awkwardly, as a new “family” of peers is developed. Again, the calmer you are—and the less your emotional security is dependent on his behavior—the better.

Also, what bothers you about this behavior? Are you concerned you or others will deem yourself a parental “failure”? Are you imagining the worst—i.e., he is headed for the penitentiary if this doesn’t stop yesterday? Are you already preparing the care package you’ll take to the visiting center, where he’ll be waiting in an orange jumpsuit? Try not to panic, as this may alienate him and scare him off. I know many productive, happy adults who went through a “dark period” in their teens. In fact, it’s better to get it out of the way now. He could also be testing you, to see how far he can go before losing (or not) your love of him. The trick as parents is loving the child without necessarily condoning certain behavior. Easier said than done. But he is and will always be your boy (even if he doesn’t express it that way). Often in the mid- to late twenties, there is a period of reconciliation where kids, now adults, realize how hard adult life really is.

Finally, the most important point of all, which may sound somewhat counterintuitive (but here goes): Take care of yourself. One thing parents forget, and I include myself here, is that we are most of all role models for our children, even when they act like we’re invisible (or annoying). Sometimes, our children will “counter-identify,” meaning they’ll take on the “reverse” identity of a parent, to distinguish themselves as different. Your son’s behavior is communicating something important to you, most likely unconsciously; it’s a good idea to try to “decode” what he’s trying to say. There’s no harm in some family therapy to seek some help in this.

Children often bridle at the implication that they are responsible for their parents’ emotional well-being. This only decreases and constrains the very freedom they’re itching to define. Of course parents get upset or angry or anxious when a child is in trouble—that’s normal—but I’m talking about something more profound, a core, existential sense of OK-ness. Parents who feel, consciously or not, that “my child’s ‘performance’ is a direct reflection of my own core worthiness” are setting themselves up for trouble.

I like the concept from recovery programs of “attraction, not promotion.” You want to provide an attraction to a peaceful sense of stability, calm, and strength which you personally embody. Not pounce and pick apart all of his behavior, which will only make him defensive and/or angry. In a way, you and his dad are the guardrails for safety, in deed and not just word. The guardrail needs to be flexible but not breakable, solid but not overly foreboding (or flimsy). Our children provoke our own need to grow and stretch as a person, and again there’s no shame in getting help. This might include therapy, Al-Anon, or a parents’ support group so you can learn from others—which would also be good role modeling for him. And any non-pressured family time, in whatever form (movies, ballgames, let him choose), will hopefully cultivate unity.

Finally, the National Institute on Drug Abuse has a page for parents on teens. There are other good resources for parents on the Internet also.

Thanks for writing, and warmest wishes to you and your family.
Darren

Thank you for your honesty in describing what sounds like an unbearably painful situation. Alcoholism and addiction basically put both the addicted person and his or her loved ones in an impossible position, where the addicted one is both there and not there, leaving the partner and loved ones to have a “split” experience with, it often seems, two or more personalities. Those who love people with addictions often have a glimpse of the “real” or true person, who is suffering and appears to want help, before the drunk or stoned person appears again: critical or self-centered to the extreme, and hurtful to be around. Thus, by distancing ourselves from the latter, we also seemingly end up abandoning the former—the sober person we fell in love with. This leaves us in a no-win position, where we can stay and feel continually abandoned ourselves (or attacked, or both) or leave and bear the burden of guilt that tells us we are leaving our loved one alone on a deserted island.

It is also devastatingly difficult, if not impossible, to imagine how or why someone would choose drinking or using over family. This is why I like the idea of addiction being a mental health issue, where a person gets to a point where he or she would rather continue to self-destruct and lose everything and everyone than stop and get help. I have lost family members to addiction, so I relate to how absolutely baffling drinking to this degree can be, and how heartbreaking.

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But sometimes things get to such a crisis point that a decision has to be made: namely, do we want to go down with the ship or not? It sounds as though you are choosing sanity, being a good mother, and what often becomes the lesser of two evils: saving oneself, setting a life-preserving boundary against alcoholism, versus rearranging deck chairs on the Titanic. Of course, the ensuing guilt is inevitable, although in truth when a drinking problem reaches such a tragic state, there is little to nothing we can really do anymore and the only real option is to take the lifeboat. By leaving, you are acknowledging the crisis, refusing to minimize it, telling alcoholism you no longer wish to be part of the problem and that you need to protect yourself and your children.

Your husband has long been in a vulnerable situation, and this moment of decision would arrive with or without your presence. The problem is his drinking is killing him, period. Everything else is almost an afterthought. No one can make this decision for him. He must decide whether he wants to stop drinking and live, or keep going and face tragic consequences. Your presence cannot soften these consequences; in fact, your absence may help clarify the starkness of his choice, so I think it’s wise to remove yourself from the situation. No matter how much you have helped him, and with what, the choice remains the same: does he stop or not? This decision and ensuing consequences are out of your control, so in spite of the difficulty you are giving him the dignity of his own choice and allowing him to decide which way he wants to go. You are also setting a good example for everyone by choosing life over insanity and death, though he might not see it that way right now.

I cannot emphasize enough the importance of finding your own support. This is an extremely traumatic situation and likely has been for some time, though that might not be obvious to you; a person’s alcohol or drug problem tends to suck all the oxygen out of the room, hog the mental spotlight as it were, so that the partner forgets that he or she also needs help.

There is no way, of course, to predict any outcome, though it is my great wish that this is the wake-up call your husband needs; people who drink or use are amazingly adept at ignoring or forgetting inconvenient truths, such as the lethality of drinking and using. Perhaps, as human beings, it is near impossible to consider our own demise. But the demise of the relationship, or at least your presence in the house, might, I truly hope, be a stark reminder of the destructiveness of his alcoholism. You are having a healthy response to an extremely toxic situation (alas). I’m sorry to say you ultimately could not save him even if you stayed.

My final point is about your own well-being. I cannot emphasize enough the importance of finding your own support. This is an extremely traumatic situation and likely has been for some time, though that might not be obvious to you; a person’s alcohol or drug problem tends to suck all the oxygen out of the room, hog the mental spotlight as it were, so that the partner forgets that he or she also needs help. Often we buy into the myth that says we are not addicted and therefore strong and resilient, such that no help is needed. To want any support or relief might even be seen as selfish: How can I think of myself at a time like this? But as the airline safety tip goes, give yourself oxygen first so you can better assist your loved one. This is, in fact, what you are doing.

Just from the distressed tone of your letter, I can say with reasonable certainty that I think some counseling and/or group support (Al-Anon, community or spiritual/religious groups for families or spouses) would be extremely valuable. It is too easy to underestimate the damage done to our own psyches by addiction; we often don’t feel it until the dust begins to settle. Then, following the guilt comes rage, hurt, anxiety, sadness, and a whole other cluster of intense emotions—not necessarily in that order. This doesn’t at all signify a person’s “failure to cope”; it is, again, a very normal reaction to an abnormally and almost cruelly stressful situation that annihilates love and tenderness, and often hope, to a traumatizing degree. It is a situation, I might add, that often parallels earlier childhood experiences where the nondrinking person became a kind of parentified child, or precocious caregiver, so that this role became second nature, where crushing guilt ensues anytime the person tries to step out of it. But any adult romantic relationship contingent on one-way giving/receiving will sooner or later collapse from imbalance. A thriving, growing love needs mutuality, or at least something in the ballpark. We need to take turns—otherwise the see-saw tips too far in one direction and falls over.

I also often say that a partner going to Al-Anon helps the addicted person too, as it is excellent role modeling.

I’m sorry you are in such a hellacious bind, though I commend you for your courage and stamina in making the sane choice (which can seem insane in the midst of chaos). Your feelings are normal for someone in your position; however, they do not, by any stretch, indicate that you are doing something wrong. It sounds like the kind of wake-up call that has been in the works for some time.

Thanks again for writing.
Darren

Congratulations! You’ve made one of the best decisions you can make: asking for help. Whether you’ve decided to get help to control or moderate your use of alcohol or substances, or whether you’ve decided you want to be entirely abstinent, or whether you just want to explore the role that addiction might play in connection to an underlying depression, anxiety, stress, or self-esteem issue, you are being proactive in trying to find someone who can help you. Acknowledging that you need help is never easy, but it’s one of the best things you can do for yourself. Finding the right addiction therapist is just as important as making the decision to get help.

Before determining whether the treatment provider is “expert” enough, you have to decide what type of practitioner you would like to consult. Addiction treatment often involves working with a combination of professionals. Probably the most comprehensive place to start would be to meet with an addiction psychologist for a complete evaluation. However, there are several other types of therapists with the necessary and sufficient experience to get you on your way. It is important to know the differences between these sorts of treatment providers.

People often will begin their search for addiction treatment by consulting an “addiction psychiatrist” or “addiction psychologist.” In actuality, these are two very different kinds of professionals. Knowing the difference is essential. Furthermore, the professions of psychotherapist, social worker, and counselor all have different specialties, and their focus and breadth of treatment can vary considerably. In most instances, their credentials are much less important compared to their experience and the connection you can establish with them. Most therapists would likely agree that the most curative factor in the psychotherapeutic relationship is the rapport that develops between therapist and person in therapy. So while you’re looking for someone you can afford, you are also looking for someone with whom you can connect.

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What Is an Addiction Psychiatrist?

An addiction psychiatrist is a medical doctor who specializes in treating people with addictive and mental health issues primarily with medicines such as antidepressants, antipsychotics, and medications that help to treat underlying mental health conditions and comorbid issues. While there are many psychiatrists who don’t prescribe medications much and focus primarily on therapy instead, most psychiatrists manage medications and work closely with psychologists and other therapists who will provide the talk therapy treatment. Subsequent psychiatric appointments following an evaluation tend to be short, about 20- to 25-minute med checks; they are mostly concerned with how a person is adjusting to a drug regimen, minimizing side effects, and gauging effectiveness.

Most importantly, an addiction psychiatrist has special training in prescribing medications to help individuals who are struggling with their substance use. It is important to work with an addiction psychiatrist and not just a general psychiatrist when you are trying to determine the nature of your relationship with drugs and alcohol and considering making behavioral changes. An addiction psychiatrist can prescribe medications to help you detox or withdraw from drug and alcohol use, and they can also prescribe medications to help you with cravings, which could avert relapse.

What Is an Addiction Psychologist?

An addiction psychologist, on the other hand, is a doctor but not a medical doctor. Addiction psychologists are trained mental health professionals who can help you explore the role that addiction plays in your life. An addiction psychologist can help you become more aware of your thoughts, feelings, and behaviors, and teach you different ways of dealing with problems through therapeutic approaches such as cognitive behavioral therapy, motivational interviewing, mindfulness-based relapse prevention, 12-step facilitation treatment, and community reinforcement and family training.

Additionally, addiction psychologists let you talk your way through a problem and help you get to the heart of the issue so you can make the necessary changes that will improve your life for the long haul, and not just put a bandage on a major wound. A typical appointment with a psychologist is 50 to 55 minutes.

Other Professionals Who Can Help

There are other types of addiction therapists in addition to psychologists who might be helpful, including social workers and licensed professional counselors. Social workers may have their master’s or doctorate, while licensed professional counselors may have only a master’s-level education, though both are trained in mental health issues to varying degrees. Social workers in particular are trained in obtaining the best social agency support services, and they tend to take a social and networking approach to the treatment of mental health issues.

Psychotherapists may have any of the above degrees or none at all. A psychotherapist is sometimes a catch-all for someone who practices talk therapy, but the therapist may or may not be adequately trained according to the standards of another professional degree or certificate. For example, a psychiatrist or psychologist may describe themselves as a psychotherapist, but so too can a recovery coach or Joe Shmoe because he’s been a “spiritual advisor” ever since he was electrocuted while trying to repair his garage door. That said, many psychotherapists do receive comprehensive training, but it is important that you vet their experience, training, and credentials, as you should with any other therapist. (GoodTherapy.org does this work on your behalf as it has strict educational and training requirements for membership.)

Certified addiction counselors and certified alcohol and drug counselors are just a few of the titles bestowed to professionals who are counselors but not at the educational or academic level of psychiatrists, psychologists, or social workers. Often, these titles vary slightly according to state board guidelines, which can be somewhat less standardized from state to state. They may be no less qualified to treat you, but it is important to see someone who is licensed in his or her professional field. Ideally, your clinician would be qualified as both an addiction counselor and as a licensed mental health professional.

Finding the Right Addiction Therapist

Now that you know the differences between professionals, let’s talk about how to find the right addiction therapist for you. There are two common ways to find a psychiatrist and/or psychologist: (1) research local addiction professionals online, or (2) identify an addiction therapist who is recommended to you by another professional, friend, or family member. Both are perfectly legitimate ways to begin your search for the best match.

Once you think you have found someone, follow these steps to determine if they are competent, credible, and a good match for you. First and foremost, check their credentials to see if they are who they say they are. Make sure they have the associated degree of the professional discipline you personally are looking for. The professional you go to should be licensed, and the license should be up to date and clearly indicated on his or her website or profile listing.

If you think you found someone but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting.

Secondly, whether you want to see an addiction psychologist, psychiatrist, counselor, or psychotherapist, you should determine what expertise the person has in the field of addiction. This can be daunting because, across disciplines, there is no standardized way of determining one’s expertise in addiction. For example, while psychiatrists can be board certified in addiction medicine, addiction psychologists might obtain their proficiency by having (1) additional certification as a certified alcohol and drug counselor, (2) by being a member of the American Psychological Association Division 50 Society of Addiction Psychology, or (3) by having conducted research and published articles on addiction. Moreover, addiction counselors may have a certification through a state board, yet they may lack the background and training that a psychologist receives in mental health issues. This is important because half of all individuals who are diagnosed with a lifetime prevalence of addiction will also be diagnosed with a lifetime prevalence of another comorbid mental health diagnosis. Furthermore, one might not want to see a psychiatrist who specializes in medication management and may not have as much training and experience in the various treatments involving the talk therapies.

Third, check reviews online. There are excellent therapists who don’t yet have reviews online, perhaps because they haven’t had an online presence or because it’s just not ethical to ask for reviews. Many psychotherapists will have colleagues write reviews for them, which is a helpful way of getting recommendations. One bad review can affect someone’s listing significantly, so look carefully at all the reviews to be fair.

Fourth, review the professional’s website and other sites where their practice might be listed to see that they offer “evidenced-based” or “best practices” treatment. While these buzzwords have quite frankly become passé and obsolete as they have been co-opted by marketers, you want to be sure that your therapist at least knows about the most up-to-date evidenced-based treatment approaches. Ask what treatment the professional uses that is evidenced-based, or ask for an opinion on something you’ve learned about, like harm reduction, 12-step facilitation, motivational interviewing, or mindfulness-based stress reduction or relapse prevention.

Fifth, have a phone conversation to see if you feel some sort of connection to your addiction therapist. This may be a feeling of confidence or an inexplicable bond of initial trust, but in either case, feeling secure with your addiction therapist is crucial. It is completely appropriate to say you are shopping for a therapist and that you’d like to speak on the phone to ask some questions or let the person know what is going on to see if it even makes sense to set up an appointment. This also allows the therapist to gauge whether you’re a good fit for him or her, and if not, to offer a referral.

Sixth, make a follow-up appointment where you can meet the person face-to-face and see if your initial instinct was correct. It is also reasonable to meet once or twice before you decide whether to commit to working with the person while you develop a treatment plan together. Remember, most importantly, you are looking for someone you connect with. You and the professional should both believe that the therapist can help. You are looking for someone you can afford, someone with whom you can feel comfortable, and someone you believe can help you.

If you’re lucky, you may get all these steps right on the first try, but many people do not. If you think you found someone, but they end up not being the right match for you, do not give up hope. It may be important to explain very clearly to this person what it is that you feel you are not getting. Often, the difficult experience you are having with the therapist is related to the reason you are in therapy to begin with. In other words, the conflict or problems you are having with your therapist may be the sorts of problems you have in other relationships and could be driving addictive or compulsive behaviors, and now you have an opportunity to work through those issues with a therapist who is trained to help you see your role in the relationship and in other, more important relationships. This is a wonderful opportunity to learn about yourself.

If your therapist shies away from this sort of dialogue, they will not be helpful to you. Sometimes, the match is just not right and you have to find another therapist. The right person is out there; you just might have to work a little harder to find that person.

Conclusion

In summary, because addiction treatment is a unique field, it is essential that your addiction therapist have a solid background in mental health and not just expertise in addiction. Since many of those with a substance use issue in their lifetime will also meet the criteria for another mental health condition, it is clear that these comorbid conditions are interrelated and may fuel each other. This is why it is so important that your therapist be an expert in both domains. When you seek help for addiction, you may experience issues such as depression, anxiety, trauma, attention-deficit hyperactivity, and relationship problems. Addiction therapists who are not licensed, such as recovery coaches and interventionists, can have an important role, but only when mental health professionals who are licensed are supervising and quarterbacking the treatment.

Once you’ve found an addiction therapist who is a good fit and you begin to understand your addiction issues—medical, psychological, and otherwise—you may feel as if a big weight has been lifted off of your shoulders. While most individuals considering stopping or reducing their drug or alcohol use are loath to imagine their lives without the use of alcohol or drugs, many recovering individuals report that their lives are vastly improved and that that their worst days in recovery are far better than their best days using.

Many people struggle with addictions in today’s stressful society. Drinking and/or using drugs, overeating, sexual compulsions, and gambling are all ways in which individuals attempt to self-soothe and forget about their problems. These misguided methods all have one thing in common—they enable the individual to temporarily attain a different state of consciousness in order to avoid looking at painful emotions they may be feeling.

Alcohol and drugs obviously create altered states of mind, but overeating, gambling, or having a sex addiction do as well. For those who overindulge, food typically brings up early memories of comfort and is used to fill up an inner sense of emptiness. Many who gamble tend to forget or overlook everything except the thrill and excitement of the potential win. For many individuals with a sex addiction, there is an attempt to seek connectedness through the sexual act, without having to connect on an emotional level.

So what are some ways that individuals can learn to cope with their emotions in a healthier way? The following steps can be taken to help overcome an addiction:

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1. Join a support group. There are many different peer-led support groups available that can be very helpful when trying to overcome any kind of addiction. Alcoholics Anonymous, Narcotics Anonymous, Overeaters Anonymous, Sex Addicts Anonymous, or Gamblers Anonymous, for example, are all groups where people can relate to others who are dealing with the same types of issues. Individuals hold each other accountable and are often inspired by others’ success stories.
2. Explore issues that the addiction may be covering up. Often, people resort to unhealthy coping mechanisms because they are struggling with painful emotions and/or traumatic situations that have not been integrated. Seeking out a qualified therapist can be helpful in working through past trauma and learning healthier ways to cope.
3. Keep track of your triggers. By noting the times you feel tempted to indulge in an addiction, you can begin to bring more awareness to the situation. For example, do you start drinking after work every time your boss criticizes you? Do you binge on fast food whenever your self-esteem is at a low point?
4. Look for the purpose your addiction may be serving. Many people struggling with addictions have difficulties with relationships. The addiction becomes their relationship of choice, and the individual may spend much of his or her time thinking about ways to indulge in it, rather than examining underlying issues related to connecting with others.
5. Learn to experience emotions rather than avoid them. Addictions are often an easy way to escape from feeling painful emotions, but this is only a temporary solution and ends up making the problem much worse. Try to spend five to 10 minutes a day just sitting with your eyes closed and focusing on the sensations in your body. Painful emotions tend to be held in the body and are typically experienced as a tightness or constriction. Practice mindfully sitting with the sensations, honoring and welcoming them, rather than trying to push them away. Remember to breathe in and out deeply when doing this exercise.
6. Journal about your feelings. Journaling is a helpful tool to get uncomfortable emotions off your chest. Whenever you feel triggered to indulge in your addiction, try to write about the thoughts and feelings that you are experiencing instead. This technique can also be useful right before going to bed, especially if you tend to toss and turn and ruminate over stressful issues.

Overcoming an addiction can be extremely challenging, but using some or all of the techniques above can be a great starting point. If you have a severe drinking or drug problem, you may need to start off with residential treatment in order to be surrounded by individuals who support you on your healing journey.

The first step can feel like the most difficult one, but recovery from any type of addiction is absolutely possible for anyone willing to reach out for help.

Thank you for your question, and congratulations on your sobriety! Fifteen months is great; clearly, in spite of your current woes, you’re doing something right.

I think the answer to your question is in the question itself. Very often relationships that feel “broken,” dysfunctional, and so on lead to an overall bad feeling about ourselves, or low self-worth or self-esteem that, actually, may precede the relationship itself. I have found in my clinical practice that it is not just the relationship that isn’t working; it is the negative way we have come to see ourselves that defines who we seek as partners.

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If we have a negative self-concept—and I know few newly sober people who don’t—then we may seek out partners who have similar challenges with self-esteem, who then tend to act negatively toward others. Why should we act lovingly toward anyone “dumb enough” to be with us? Or, the flipside of the same coin: we feel we must treat with utmost deference anyone who would be gracious enough to come into our lives, since he or she is doing us such a tremendous favor. We therefore tend to dish out or absorb hurtful behavior that reflects a primal woundedness, unhealed and unconscious, guaranteed to keep us in relational unhappiness until squarely faced.

Your boyfriend treats you with much less than the respect and care you deserve—and you are obviously a caring soul—leaving you in a state, I would imagine, of bewilderment and pain. I would assert that abusive relationships, too, are cunning, baffling, and powerful, probably because there is an aspect of the partner that is “good” or caring and aware of the hurtful outbursts, perhaps even expressing remorse after the curses and fists have flown. We also might feel we “get” the person more than anyone else—that he or she is a sheep in wolf’s clothing, etc., and deserves a chance when everyone else is so against him or her. (Surprisingly, I see a lot of abused husbands and boyfriends in my private practice.) But then it happens yet again, similar to a person with alcoholism who rages while drunk and then makes “never again” promises or refuses to talk about it.

If we have a negative self-concept—and I know few newly sober people who don’t—then we may seek out partners who have similar challenges with self-esteem, who then tend to act negatively toward others.

It is not at all uncommon for people who have gotten clean and sober to discover a secondary “addiction” or compulsive behavior (or even relationship or some kind). What you have going for you here is a dawning awareness that there is, indeed, something wrong with this picture: an excellent place to start. Try to keep your eyes and senses open to what your actual experience is here, rather than what “ought” to happen or the “tomorrow” that might be better. I also suggest that you try one or two possible options, namely Al-Anon or CoDA (Co-Dependents Anonymous), as well as counseling, since the roots of your own relationship perceptions and beliefs probably, I venture, go very deep indeed. You might also seek out a women’s group in AA or a women’s group where you can talk about these issues (often shameful and painful to discuss with others) and find proper support and feedback from others who have walked in your shoes (or similar shoes). It can be even more difficult to “quit” an abusive (or something like it) relationship, since we so often feel a strong tie with the “caring” or more aware part of the person per the above, even if he/she can’t or won’t stop. (And don’t believe for a second, in your case, that he can’t; he can, trust me, if there is enough consequence for his not doing so—i.e., losing the relationship!)

It’s time to learn new ways to enforce boundaries, in other words, just as you have done so superbly with the drugs and booze: here again I suggest you define and then communicate to him and, if need be, enforce these boundaries against any verbal, emotional, or physical behavior that crosses the line. There’s no shame in the fact this is difficult, given longstanding beliefs and convictions about ourselves and what we do and don’t deserve, beliefs which may again be unconscious or unarticulated. If we grew up in an abusive environment, we learned that we “must” tolerate chaotic or hurtful behaviors that become commonplace.

Finally, regarding the idea that your kids “should be enough”: watch out for “shoulds”; they only make us feel worse about ourselves. A relationship with children—and congratulations on making amends in that regard, by the way—is naturally quite different than one with a partner. It’s rather like saying, “Why do I need to eat vegetables, I eat plenty of protein and grains”; holistically speaking, we seek and desire different types of love, and naturally, parental love is quite different than intimate or romantic love, which is different than having good friends, etc.

Also, try to remember that you are a role model for your children. You don’t say if you have daughters or sons, but in either event your children will look to you as a prime example of what to expect from women (if they’re male) or how/what women ought to tolerate in their lives from men (if they’re female). Also, I wonder if your ex-husband might feel more comfortable with expanding visitation times if he knew the boyfriend had stopped his acting out or (if he won’t) were out of the picture? Is it safe for your kids if he is around? I don’t know the details, but it’s something to consider. Thanks again for writing. And keep up the good work in your recovery!

Best wishes,
Darren

Thank you for your question. Boy, oh boy were you put through the wringer. My heart ached to read of your experiences. I suppose the short version of my answer would be to see a therapist soon as you can, if only for the reason that you mention suicidality from your teens and depression today. This is not to be alarmist, but depression is something you don’t want to go unaddressed for long, more a sign of trauma than any “character issues.”

Clearly, your mother’s traumatic flight and your dad’s withdrawal left psychological scars that now need attending. This is not to blame anyone; the tragedy of mental health issues (you mentioned your father’s depression) is that those afflicted often end up passing on their condition by creating, as the authority figure in the home, a psychological mood or atmosphere of depression, anxiety, etc., which children are liable to absorb. They don’t call them the “formative years” for nothing. These wounds are passed along from generation to generation until someone has the courage to say “enough” and get some professional help. The good news is that you are young and in an excellent position to get help, and in so doing, start life over again and find contentment and purposeful living. Your experience, believe it or not, can be a vehicle for compassion and empathy for others down the road.

I am a fan of author and psychoanalyst George Atwood, who says in his excellent book The Abyss of Madness that, to paraphrase, people become depressed when depressing things happen to them. There are so many ways in which your trauma would upend anyone’s psyche. The most common question people ask me is, “Is this normal?” I usually say I gave up on normal a long time ago. Also, we therapists can relate to the childhoods and suffering of the people we work with more than we sometimes let on.

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Yet another wounding occurs when the abandonment pain is not acknowledged or permitted to “exist.” A depressed parent may withdraw for self-protection and neglect the child, who cannot help but take it personally. Of course, as a young adult you now want to drink alcohol and blot it all out. What happened was wounding indeed, but not only were you alone with the abandonment, but you also had no one to even acknowledge or help you cope with its scarring legacy. Thus you were in the impossible situation in that you couldn’t have or not have these feelings; the terrible loneliness you experienced was compounded by not having a caring witness to empathize and help bear your very understandable feelings—a kind of solitary confinement.

You sound like a psychologically resilient person who survived a very difficult upbringing, who cares enough to do something about it now. I would encourage you look for a therapist who understands the kind of trauma you experienced, someone who is willing to be patient with you as these injuries to selfhood—which, actually, you seem to have borne quite nobly or you wouldn’t even be writing—begin to heal. Consuming vast quantities of drink or drugs is understandably tempting, but I encourage you not to. In the end, it will only erode your self-esteem and, in a sense, repeat the abuse by neglecting the hurt that needs a safe place for healing. You’re worth the effort (even if it doesn’t always feel like it). Thanks again for writing.

All my best,
Darren