When a loved one is ill, we seek treatment. There’s a protocol for almost everything, and we trust the experts — professionals who have experience and science to back their recommendations. Addiction is different. It’s only recently been recognized as an illness, as opposed to a behavioral choice. Like many other illnesses, addiction starts with a genetic predisposition. There is something different about the brain of an addict, or potential addict. The reward center is involved – in addiction, delayed gratification is a concept that’s hard to grasp. An addictive mind is typically inwardly focused and may be lacking in empathy. Already feeling disconnected from society, an addict can be very lonely and isolated, even before an addiction is established. With an addictive mindset, discomfort of any kind is commonly intolerable. While many of us experiment with substances or behaviors at a certain stage of life, for an addict it’s impossible to move through the experimentation phase and on to a more sustainable way of life. In short, a potential addict never stands a chance. One time is too many. Unfortunately, many losses will occur before an addict admits there’s a problem, and the process of recovery is typically rife with backsliding and “reframing” of circumstances before a healthy way of life is established.
There is a protocol for addiction, women on drug treatment, counseling and, often, psychological medications for co-occurring illnesses. However, its application has extremely low levels of long-term success. Families should be advised of this fact going in. However good the program, if the patient isn’t ready or is unwilling to change, progress will be short-lived. To make matters worse, treatment is expensive, especially if the addiction is ongoing or resistant to change. Even if insurance covers part of the treatment, the out-of-pocket output can be devastating to a family. The burden, financial and otherwise, indeed falls upon the family of an addict. Addicts are seldom “functional” and typically have a hard time holding a job, paying bills, keeping up with classes or maintaining healthy relationships, and would certainly have trouble affording treatment.
While psychology, in general, is widely variable, with results of treatment differing from one individual to the next, with addiction, certain behaviors are “textbook” and familiar to anyone close to an addict. An addict commonly considers himself “unlucky” or a victim of circumstance. Addicts have trouble understanding that their actions create their realities. As such, they typically target others as the cause of their issues. They feel misunderstood and unsupported, contrary to reality. Addicts are master manipulators, playing upon sympathy or pity to get what they want. Sadly, addicts usually have extremely low self-esteem based upon their lack of success or ambition in life, which leads to a vicious cycle of expecting little going forward, and living up to that expectation.
Families will typically trust the system at first, pouring emotional support, energy, and funds into the recovery of their loved ones, often losing touch with their own lives in the process. If the addict is not ready or willing to make a change, the cycle will repeat, often with a dramatic worsening in between treatments. The addict can become bitter and resentful of any ultimatums or perceived lack of support, and may even resent “being controlled” in treatment, still believing he has a handle on just how close to the edge he can live. The situation can escalate to police involvement, jail time, or worse.
During this time, sometimes lasting for years, families are advised to create hard boundaries, to avoid “enabling” the addictive lifestyle. This approach has unpredictable results because each family member has a different tolerance for becoming uninvolved in the life of a loved one. The goal of creating a “rock bottom” that will result in an epiphany, or at least another attempt at treatment, is hard to imagine before it happens, and loved ones are left guessing: is being unemployed rock bottom? How about being homeless? Jail?
An addict is hard to be around for extended periods of time, so friends and other relationships will begin to fall away. Typically there’s one family member that tends to be the default, or the “last man standing”. Ironically, this default loved one tends to be the mother. However disfigured by addiction, the best of the heart and soul of an addict will always be recognizable to his mother. Being the only supportive person can be an enormous burden, even if enabling is not part of the picture. Understandably, this dynamic can be devastating to the family structure. A good family counselor is crucial. Support groups can also be amazing for family members who are open to them. An addict in the family is terribly isolating, as families don’t broadcast what is going on behind closed doors. Hearing the stories of others can be a great comfort. Since the behavior of all addicts is similar, it’s a relief to understand there are others in the same circumstance.
Families are advised to keep seeking treatment, aiming for one more ultimatum, or rock bottom, if necessary. If money’s no object, this is indeed the ideal course of action. Families should be counseled, however, that lasting healing will not occur until the addict decides to change. Until insurance begins to pay more for this treatment, families may need to decide to back off and wait for an indication that it’s time to, once again, invest in hope.