Alternatives to Drug Rehab?
January 4, 2006 4:44 PM   Subscribe

Does this seem like a good alternative to my daughter going to rehab for drugs?

My 20 year old step daughter has a problem with drugs (Cocaine & at times Heroin and/or Meth) and a diagnosis with a Borderline Personality Disorder. She came to our house last evening because her and her friends were being evicted from the apartment she has been staying in for the last month and a half. Before last week we hadn't seen her in over a month. She finally admitted that she has no place else to go.
We went to the ER last night to see about an assessment but because she told them she didn't have a problem she was sent home with a referral to a mental health clinic.
My wife and I want her to go to rehab which she is very resistent against because she doesn't want to spend her 21st birthday (10 days) in Rehab. I told her I want her to be alive for her birthday. I also have to try and protect our much younger children from her histronics and unpredictable behavior.
Today I gave her three options:
1. Rehab. Several different choices of location but difficult because she doesn't have insurance.
2. Leave until she's ready to clean up.
3. Home Boot Camp
a. Piss Test on demand (She failed the first one for Pot, Cocaine and Meth with a questionable result for Opiates)
b. Get into counseling/Go to N.A. meetings
c. Get a job
d. Stay away from her druggie friends (the only ones she has)

I think the only real option that will work is Rehab but I am only offering our home is because I am afraid of where she will end up if she leaves and by it being so odious maybe she will decide that Rehab is preferrable.

Any other suggestions would be greatly appreciated.
posted by mickbw to Human Relations (37 answers total)
 
don't go the NA route. They will teach her that she is powerless over her vices and only god can help her... i mean, unless thats your thing. thats all i got. Hope she gets her ducks in a row soon :T
posted by Tryptophan-5ht at 4:56 PM on January 4, 2006


Speaking as somebody who had some "Presidential" habits when I was her age, I'd also recommend against _____ Anonymous, for the same reason that Tryptophan-5ht gave.

Also, if you can find it in you, I'd recommend turning a blind eye to pot.

The good news is that she's come to you in some form, even if it's a selfish form.

If you can find any way to talk her into rehab, that's a very good thing. Even if she relapses later, it will likely plant the seed that hard drugs aren't actually fun, even though they sometimes seem like they are.

I wish you all the best, in what is a very difficult situation.
posted by I Love Tacos at 5:04 PM on January 4, 2006


Rehab's the only good choice in your list. I've seen alternatives, including the ones you've listed, tried many times, and never with a good result.

The success rate with rehab is far from 100%, but as I've observed from friends' experiences, it's far better than the results of other methods of helping someone get clean.

Maybe spending her 21st birthday in rehab will help her make this a turning point in her life for the better. And if you believe in prayer, you should probably start now in earnest if you haven't already. Even if you don't, it can't hurt. Neither you nor she are powerless, but get all the help you can, professional and otherwise.
posted by JekPorkins at 5:06 PM on January 4, 2006


My heart goes out to you. I've worked with individuals who had drug and psych problems and it's not uncommon for them to have multiple rehab attempts, especially with the drugs you mentioned. Frequently the family takes damage almost as great as the as the person abusing the drugs. Counseling is good. NA can be good, but some NA meetings are great places for scoring, and she may develop relationships with some of the other persons at the NA meetings and relationships between two addicts at NA meetings frequently results in both addicts relapsing. The Boot camps may be terribly stressful to your family. She's 20 now, and won't take well to drug tests and "nagging" (as she would perceive it). Rehab can be useful but it's not uncommon for persons to use immediately after leaving rehab. I think rehab, with counseling after leaving rehab, is the best possible treatment.

I don't mean to be terribly pessimistic but I do hope that you can begin to consider this may be a long drawn out struggle, rather than something that may be easily fixed. Take care of your family. Take care of yourself. Help her when she asks for help but recognize your boundaries.
posted by aliksd at 5:12 PM on January 4, 2006


I'm sorry if this seems abrasive, but what in the world is wrong with your relationship with this girl? You're offering your home as an option only because you think the idea of being there is bad enough to send her to rehab? You want to protect your young children from her behavior, but you haven't really given an indication of how she got into this mess in the first place. In addition to that, rehab is difficult because "she doesn't have insurance"?

If you really care about her, you'll check her into a rehab program, pronto, and find a way to pay for it. Pot is not such a big deal, but I've seen plenty of people die from heroin use and the idea that she won't get excellent care because she has no insurance is repulsive.
posted by booknerd at 5:20 PM on January 4, 2006


I think she is planning to party for her 21st birthday. That's why she doesn't want rehab. If that's her attitude, a home boot camp deal would just prolong things.
posted by lester at 5:27 PM on January 4, 2006


I second the leniency on pot. my ex room mate kicked meth for pot when he was 15. Substitution yes, but at least it doesn't devour small portions of the brain at a time and its infinately easier to give up.
posted by Tryptophan-5ht at 5:32 PM on January 4, 2006


"at times heroin"

Is there such a thing as an occasional heroin user??

Rehab. But as others have said, only if she's ready. Watch a few episodes of Intervention on A&E. If she isn't ready to get clean, she won't get clean.
posted by clh at 6:07 PM on January 4, 2006


Ignore booknerd, or at least his/her calousness. Dealing with problem children bouncing back into the house because they've made, to put it kindly, a mess of their situation is something I can relate to. I have heard that generally rehab IS very expensive (and I know who'll be on the hook for that) and the success rate is low. All I can say is that if you let her live with you there should be responsability and accountability on her part. People will get away with as much as you let them get away with. Under my roof I wouldn't tolerate pot or drinking. Don't let her forget whose house it is and who is the guest. Good luck.
posted by JamesMessick at 6:10 PM on January 4, 2006


When you say "home boot camp," I hope to God you don't mean any of the abusive "troubled teen" boot camp companies described here. Many parents in your situation, frustrated by institutions that don't seem to take drug situations seriously enough, book their kids into one. They go in with emotional problems and come out much worse.
posted by johngoren at 6:21 PM on January 4, 2006


Get ready for a bunch of people telling you that she has to hit "Rock bottom" before she can get better. It's a bunch of crap, IMO. No scientific evidence that it's true.
posted by delmoi at 6:33 PM on January 4, 2006


Yeah, and I'm curious why you want to make her home "odious" with this home bootcamp BS. You're not a psychologist, stop pretending to be one.
posted by delmoi at 6:36 PM on January 4, 2006


If you make your home unbearable, and she dosn't want to go to rehab, you're just going to push her out on the streets to be a crackwhore. Is that what you want?
posted by delmoi at 6:37 PM on January 4, 2006


Until she really, absolutely, is 100% dedicated to changing her lifestyle, she'll never beat her addictions and histrionics. Even if she's committed to beating the addictions, her histrionics will cause her to relapse, I'm sure. She needs a complete lifestyle and personality shift, and no cookie cutter solution will work. It'll take either complete divorce from her life on her own accord or some other unique solution. Good luck.
posted by cellphone at 6:52 PM on January 4, 2006


Is there such a thing as an occasional heroin user??

Apparently the only thing you ever asked this question before was Hollywood.
posted by cellphone at 6:53 PM on January 4, 2006


Completely off the wall suggestion: Is there an out of state relative she could stay with for a while? Sometimes it helps to be completely removed from the situation especially from the friends that party with her.
posted by chiababe at 6:59 PM on January 4, 2006


Is there such a thing as an occasional heroin user??

Yes.
posted by TimeFactor at 7:14 PM on January 4, 2006


mickbw: None of it is going to work until she's ready to make a change (hitting bottom or not). You can only make those options available to her. Let her know that you love her and are willing to support her when she makes the decision to clean up.

I second the suggestiong to watch a few episodes of Intervention on A&E. It'll show you what can/may happen and it shows you you're not alone in your situation. Also Al-Anon meetings can be a help as well.

It looks to me like mickbw's "Boot Camp" is simply a set of rules his daughter would have to live by if she stays at home. It makes sense to me - I had to live by my mum's rules when I lived at home (as did my brothers).
posted by deborah at 7:35 PM on January 4, 2006


What isn't being addressed much in this thread is the BPD diagnosis which may be feeding into/a root caause for the substance abuse issues. Dialectical behavior therapy tends to be the best treatment for BPD, and if she can get into the mental health system, (don't know what NH is like in this regards) there might be some amount of funding for DBT and the substance abuse treatment.
IMO the BPD is going to be allot harder to deal with then the drugs.
posted by edgeways at 7:53 PM on January 4, 2006


edgeways writes "IMO the BPD is going to be allot harder to deal with then the drugs."

This should be your first-line priority, I think. Is the BPD being treated at all right now?

Good luck.
posted by mr_roboto at 8:08 PM on January 4, 2006


Is there such a thing as an occasional heroin user??

Definetely. A young woman of that age with no direction and no job and a possible mental disorder is pretty much guaranteed to casually use drugs. IMHO that doesn't make her an addict and if it's pot heroin or coke she's doing occasionally I think the bigger problem is the rest of her life. Meth, however, will destroy a person pretty damn fast. You don't hear about people hiding meth habits for years because it's not possible. I think you need to sit down and talk to her honestly about what she's been doing and what she perceives as the biggest problems in her life and what she wants to do. If she's doing drugs because she's bored and wants a change but doesn't know how, maybe you can help her think outside the box about acheiving her goals in life. When you're 20, everything is a huge deal and problems get insurmountable pretty quickly.
posted by fshgrl at 8:26 PM on January 4, 2006


Contact your community mental health center tomorrow. Get her in for a screening/assessment. Mental health issues and substance abuse issues go hand in hand many times and a case manager would be of great help in pointing her towards the resources she needs. But she has to want to make a change.

Good luck.
posted by whatideserve at 8:40 PM on January 4, 2006


Is there such a thing as an occasional heroin user??

I used opiates when prescribed for pain, and never had any urge to use them when not in pain. Heroin is just morphine with some extra acetyl groups which help it dissolve through the blood brain barrier. Heroin is only slightly more addictive then nicotine (of course, most smokers are pretty damn addicted)
posted by delmoi at 8:44 PM on January 4, 2006


Also, take care of yourself and your family if you decide to take her in. Get a counselor or coach for YOU as well as helping her to find some resources. This will help you to determine and maintain healthy boundaries with her.
posted by jeanmari at 9:21 PM on January 4, 2006


I might be a bit harder than the rest. I know too many alcoholics and other substance abusers.

So it's simple. She wants the adulation (drugs, partying) for her birthday. She wants validation for the fact that everything is great, Woo-hoo, let's get drunk, on my birthday.

Do you really want to save her? It's rehab, or she lives outdoors.

Why the *HELL* didn't she come clean at the ER? Too judgemental? Either she resigns herself that she has nowhere to go, and wants, craves, admits her need for help....or you say to her, you love her so much, you can't see her self destruct.

Some people have to hit bottom - and any enabling you do, stands in that way.

She's already failed #3 - home boot camp/piss test.
NA and other XA programs often rely on strenght - she's already shown she'll lie to get out of help (at the ER).
and who do you realistically expect her to spend her birthday with, but her druggie friends?

I'm sure she's self medicating (ie drugs), the BPD is serious...but until she gets cleaned up, no talk/drug therapy is safe.

So, it's either - rehab or the door. Quit avoiding what you know you have to do here.

And expect her to hate you, and everyone else, and throw a hissyfit.
posted by filmgeek at 9:30 PM on January 4, 2006


sometimes when people hit bottom they stay there. It is easiest when people want help, but sometimes they have to be convinced they need help. With BPD the indivdual may never come to that conclusion on her own.
posted by edgeways at 11:01 PM on January 4, 2006


Hey, look, I know having kids going through this kind of thing can tear you apart and it's an incredibly complex and difficult connundrum, but aren't you enabling her by allowing her back into your home? That's too simplistic, sure, and of course IANA shrink/social worker/psychiatric professional, but I think letting her stay at home is a quick route to dangerdangerdanger, for her and for your younger kids (and you, of course). What do you do when the piss test comes back positive? Does she get a second chance? By allowing her to stay under your roof before she's completely clean and committed to staying that way, you're giving her a stable base of operations for her drug use.

If you wanted to do a home boot camp, I think frequent sessions with an addiction specialist shrink should be part of the process. But just know that she'll keep hanging out with her druggie friends. The couple of friends I've had who've endured addiction and recovery said that getting out from under that circle of friends/fellow users was the hardest part.
posted by incessant at 11:02 PM on January 4, 2006


I've kicked a few nasty habits, and am still an occasional drinker. For what little it's worth, I've never seen anyone give up a drug or drugs unless they actually wanted to. It's not at all clear that your daughter wants to stop. Until she has a real, internalized reason to do so, well, (in my opinion only, of course), it may not happen.

These things vary a great deal from person to person, though, of course.
posted by stavrosthewonderchicken at 12:33 AM on January 5, 2006


The BPD is definitely the major culprit imo. All the rest are probably symptoms of it. I don't know how you'll go about making her do this, but if you could have her start by talking to a therapist who is experienced in this area and can build rapport with her, that might help.

GL.
posted by Devils Slide at 5:07 AM on January 5, 2006


I vote home boot camp. Homelessness fucking sucks and with untreated BPD/drug problem she will go the crackwhore route. AIDS is incurable and so is a fatal gunshot/stab wound. Just too risky.

For slightly less money than rehab would cost, you may be able to get her into daily or twice week counselling as well as hiring someone to check up on her while you're at work/supervise her for the job stuff too. Or, alternatively, someone to assist looking after the younger children and shield them from this behavior. (Please don't value the little kids over your daughter. The same, God forbid, could happen to them, one day.)

There are also well developed non NA meeting type solutions too in many cities.
posted by By The Grace of God at 5:17 AM on January 5, 2006


Also, I only vote home boot camp if she absolutely won't go to rehab. Alternatively you can do the home boot camp for 10 days and then send her to rehab.
posted by By The Grace of God at 5:32 AM on January 5, 2006


Home boot camp won't work.
If you let her stay she'll already know she's won.
When you go to work she'll leave to get high. When you go to sleep she'll leave to get high. If you sleep in shifts and take time off work to watch her 24-7 she'll find a way to sneak out while you're in the bathroom.
And because she's at home and didn't get kicked into rehab she knows you won't do anything about it other than yell and scream.

She doesn't want to get better, and you, personally, are not equipped to deal with what she will put you through. She flat out told you she doesn't want to go to rehab so she can get fucked up on her birthday!

You have a marriage to think about. You have other children in the house.
Rehab or the streets, you can not give her any other option unless you are willing to sacrifice your marriage for the sake of pandering to a junkie, and cause god knows what kind of psychological damage to the other kids as well. Do you want them to see her high? To watch her nodding out mid-sentence? Or, god forbid, to discover her should she OD in your home?

Maybe I'm being too harsh, but I watched someone very close to me destroy himself with a heroin addiction, and this is the shit I went through when we decided to go the "home boot camp with drug tests on demand" route.

My email's in my profile if you want...
posted by Kellydamnit at 7:47 AM on January 5, 2006


Absolutely (to what BTGoG said). If she is indeed borderline, do not under any circumstances (unless she's attacking you with an axe or something) throw her out in the street. Horrible things can and probably will happen.

You know the pat psych answer for every disorder and malady is a combination of nature and nurture, but a lot of people suffering with BPD suffered grave abuse at a young age, and you as a parent cannot kick her out to face god knows what because she's suffering from mental illness. She's your baby and at age 20 you still bear some responsibility for her.

So set some guidelines (not too harsh), look into rehab or therapy (a lot of therapists do pro bono work, although most are wary of BPD), and if she tries to tow the line, encourage her and shower her with love and acceptance. It's what they crave more than anything.
posted by Devils Slide at 7:56 AM on January 5, 2006


A lot of your options on that list have to do with controlling her. That isn't possible. You: go directly to Al-Anon, and grab someone there to talk to who has personal experience with children.

I'm not sure what to make of her drug use from your description. But I'll infer that she needs, at some point in time, two kinds of treatment--mental health and chemical dependency. Many facilities are set up to handle both.

The real sticking point, it seems to me, is that you have younger kids in the house. This limits your ability to house her; you need to make clear what you expect and also make equally clear what the consequences will be when she doesn't meet your expectations. AND STICK TO THAT.
posted by RJ Reynolds at 8:14 AM on January 5, 2006


Why are therapists wary of BPD?
posted by By The Grace of God at 8:31 AM on January 5, 2006


First step - you and your family go to Al-Anon. It is a fellowship that is ENTIRELY about the situation that you're in: how to live when you have a loved one who is addicted to something. You will hear many different stories, and many different solutions that people have used. Some of them will contradict each other, but hopefully you will connect and feel some support to give you the strength to figure out what you need to do.

Second step - I'd recommend you take a look at this book. It's written by Stephanie Brown, a therapist and researcher here in the SF Bay Area. (disclaimer - I regularly consult with her, so I'm not entirely objective here) There are other self-help type books out there about your situation - go to a book store and browse, find one that speaks to you.

I'd advise you not to get stressed out about the BPD versus addiction issue. From a treatment perspective, I find that the thing that makes the most sense is focusing on the addiction first, as that colors everything else. I've often found that what appeared to be symptoms of BPD turn out to clear up when someone is detoxed.

As to getting her in treatment - I'm afraid that this is not a simple matter, until she's ready for it. This is very difficult for families to go through, as you're watching a loved one basically killing themselves. Sometimes people have success with interventionists. Interventionists are clinicians who arrange meetings between the resistant-to-treatment addicted person and their family/friends. The point of the meeting is to help the addicted person have an experience where they are able to see and hear about the effect of their behavior on their loved ones. If you pursue this route, make sure you get a good interventionist, as this is a skill set that has changed appreciably over the years. It used to rely on shock value, but the route isn't advisable anymore, IMO.

Good luck to you and your family. Feel free to email me if you'd like.
posted by jasper411 at 9:38 AM on January 5, 2006


Why are therapists wary of BPD?

It's very hard to treat and seems to just run its course until the person mellows out in their late 30's or 40's (if they make it to that age, as risky behavior, volatile relationships, drug and alcohol abuse, road rage etc. may cut their life short). It usually requires long term therapy, which is difficult considering the BPD sufferer may be unlikely to follow through. And of course the issue of transference is amplified when dealing with a BPD sufferer, which can freak out shrinks.
posted by Devils Slide at 6:57 AM on January 6, 2006


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