My brother is 100% dependent on marijuana. How can I help him?
July 20, 2018 2:58 PM   Subscribe

He's been using age 13 and he is 20 now. He will literally break down into full blown hours long anxiety attacks if he doesn't have marijuana. Is his only option rehab?

There is just way too much history that goes into this so let me break down the important details.

-He first used at age 12, started smoking regularly by age 14, and has been a daily smoker since at least 16.
-He is dealing with extreme depression and anxiety and is getting seen by a psychiatrist. He is prescribed sertraline, propanolol, and recently klonopin in a bid to get him to use MJ less. His psych knows all about his situation and is actively treating him.
-He refuses to see a therapist, we have taken him to one that seemed like he was helping and then he wouldn't go anymore.
-He got caught smoking weed on campus in his senior year of high school and got expelled. He finished online. He's also been arrested twice for weed as a minor.
-He has been out of work for a year and a half after a short stint working at a nursing home. He said conditions at the nursing home were so horrible that he couldn't work there anymore and developed chronic stomach pain and vomiting. Months of doctors, tests, bloodwork, scans etc and there was nothing wrong with him. At this time no one would listen to me that this may be MJ-associated Cyclical Vomiting Syndrome or overall caused by anxiety.
-He is also addicted to fast food and video games. He sits in a dark room all day and smokes weed and binge eats. He HOARDS TRASH IN HIS ROOM.
-You may be thinking: if he has no job where is he getting money and weed? He has a dealer friend that he likely owes thousands to that will give him weed. My mom will give him money sometimes even though she denies it. If he gets any kind of money he will spend it all on video games, chinese food and mj. His birthday was Sunday and he's already run through it all, he has literally zero impulse control.
-If he doesn't have any weed he'll go into hours long panic attacks and severe anxiety. If he knows he will run out soon, he'll also freak out about that.
-On top of all of this he is incredibly manipulative, aggressive, selfish and lazy. He's stolen hundreds of dollars from my mother and stepfather, stolen MJ and money from me, and may have pawned my mother's jewelry. He contributes nothing to the household and is a financial drain on my mother, who is extremely affected by the stress of this situation. (I know that this is being exacerbated by his mental health status but for the most part he's always had these traits.)

I try my hardest to maintain a compassionate approach to dealing with him because I know he has a lot going on right now. His anxiety is debilitating and real. However, he's being treated for it. In my unexpert opinion due to using at such a young age he has never learned how to deal with his emotions and uses weed to cope. If he doesn't have any weed then he's left with literally zero coping skills, and I can't imagine how terrifying this is for him. We're at our wits end with him and I can imagine he's feeling pretty done himself. I don't even know anyone who has gone to rehab for weed. Is rehab the only option?
posted by marvelousmellitus to Human Relations (17 answers total) 6 users marked this as a favorite
I would recommend that your mother, stepfather, and you start by making an appointment with a local family therapist who specializes in addictions. They can help connect you with more resources and examine the interpersonal dynamics; they can help you cope better with the stress and make a plan for how you can help. I'm sorry this is so hard, and it breaks my heart that you are all hurting so much. I really hope your brother can get the help he needs, and I'd start by putting your own oxygen mask on.
posted by smorgasbord at 3:04 PM on July 20, 2018 [19 favorites]

I would look into a hospital-based inpatient program that specializes in dual diagnosis. I mean, the problem here is not the weed, the problem is the crushing mental illness that he is barely self-medicating with weed and clearly not getting appropriately treated by his p-doc, probably because he has not been properly diagnosed.

He's 20 though, so he's going to have to want to go. You could try appealing to "wouldn't you be so much happier if you were getting good treatment that helped instead of *gestures*?"
posted by Lyn Never at 3:49 PM on July 20, 2018 [30 favorites]

Came here to suggest that you look into Alanon. Support for families of alcoholics and addicts. (The literature is oriented to issues with alcohol, but it applies to any sort of addiction.) Because this is an extremely difficult and stressful situation for you. If you wish to be helpful to your brother and mother, you must take care of your own needs first. Put on your own "oxygen mask" before you try to assist others. :-)

Alanon may or may not be right for you. If you attend a meeting or two, you will certainly meet people who have similar challenges with family, and can tell you what helped.

Also NAMI is an excellent resource for people suffering mental illness, and their families. There are online forums. You local chapter may have support groups and/or workshops. There is a NAMI seminar for family members, called "Family and Friends."
posted by valannc at 4:08 PM on July 20, 2018 [7 favorites]

It seems that his anxiety and associated mental health issues are the problem here, not the MJ.
posted by k8t at 4:13 PM on July 20, 2018 [21 favorites]

Does he want to be helped? Has he asked for help getting off weed? If not, I'm afraid you can't help him.

I'd look at going to an al-anon meeting for yourself, maybe your parents, if they're interested.
posted by hydra77 at 4:14 PM on July 20, 2018 [5 favorites]

I mean, as a counterpoint to the idea that he needs rehab and this is a Big Serious Emergency, have you considered just encouraging him to get a boring or dumb job so that he can live in an apartment with a few other aimless young men who enjoy video games and weed, which they buy at their leisure and without the opprobrium of their parents? A few years of that may motivate him to smoke slightly less weed so that he can get a somewhat better job and maybe a girlfriend, and in the meantime his toking hours will be naturally limited by his schedule at the Best Buy.
posted by Snarl Furillo at 4:45 PM on July 20, 2018 [45 favorites]

I came in to ask the same question as hydra77: Does he want to be helped?

I'm a recovering addict and my suggestions here are coming from that perspective, although obviously everyone is different. Apologies for the wordiness - I have a lot to say on the subject.

As cliched as it sounds, if he doesn't want help, any attempts to help him are very very very unlikely to succeed. I'm unclear from your question whether you want specific resources you can point him to, or a way to get him to want to use those resources. I'm going to proceed as though you're looking for ways to encourage him to seek help.

My suggested first step: ask him what he wants. It might be productive to phrase it in an open-ended way - rather than asking whether he wants to quit using marijuana, ask if he's interested in trying to explore/experiment with ways to cope with his anxiety and depression besides marijuana. The thought of going without it likely terrifies him if his anxiety is that severe without it - personally, the thought of "this is an experiment and if it doesn't work out I can always go back to using drugs" was surprisingly reassuring and encouraging.

Harm reduction is also an option - make sure he knows that. In this case, it would mean reducing his use. You might want him to stop entirely, but if he doesn't want that it's not going to happen.

Next, if he expresses interest, hit him with information. Do your research about the negative long-term effects of marijuana. Be honest with your info - denying marijuana's benefits to anxiety will get you dismissed as fear-mongering - but find reliable evidence that long-term use in excessive amounts can worsen depression and anxiety, and that it can interfere with the efficacy of his prescribed medication (so he might think the pharmaceuticals aren't helping, but he hasn't really given them a chance).

You can also help him brainstorm other things to do with his time so that he doesn't spend all his time in his room all day. Again, only if he wants this, otherwise he's going to end up resentful.

(Sidenote: if he agrees to try and stop using, make sure he knows about the length of time it takes for your body to recover from addiction. A lot of addicts quit then go back to using because they think the way they feel after a few weeks is the way they'll feel forever without their drug of choice. People sometimes don't mention this because they don't want to scare people away from quitting, but the idea that he'll go to rehab for a few weeks and emerge 100% recovered is a pipe dream and he'll likely just go back to using).

To finally answer your actual question about whether rehab is the only option: no, but it is an option. I know people who've gone to rehab for marijuana addiction. Out-patient rehab is also an option a lot of people don't know about. Instead of the rehab people typically think of where you're locked up for a month, out-patient means you go home at night. It can be anything from a couple hours a week to the whole day every day. This might be less scary than "going to rehab" (and means you're less likely to slip into old habits after you're done, because you're not separated from your normal life).

There are also various groups. Narcotics Anonymous is accepting of people with marijuana addiction (although I have many issues with NA that I shouldn't waste your time with). SMART Recovery is another, more scientifically substantiated, option. There are likely other groups in your area. Again, do your research. Different groups appeal to different people. It doesn't have to be the stereotyped 12-step experience, if he wouldn't be into that.

Lastly, you're going to have to accept that you can't change him if he doesn't want to change. Several people have been aghast that I'm not constantly telling my alcoholic parent to quit drinking or trying to get them help, but years of experience have taught me that it won't change anything. When I quit using, it was because I decided one day that it wasn't worth it anymore. No amount of other people telling me to quit or that drugs were bad could've changed my mind. I knew drugs were bad - I just thought the alternative was worse.
posted by ersatzhuman at 5:09 PM on July 20, 2018 [17 favorites]

CBD oil can be effective against anxiety and won't get you high like smoking does -- I've got a 1:20 THC:CBD oil that is super effective for me for maintenance/prevention of anxiety, but a 1:3 or 1:1 can be way more effective for getting through an acute anxiety issue. Ask him to try it and see if it lessens his desire to smoke weed.

If it turns out he just really likes to be high, then that's an issue that needs to be dealt with.
posted by erst at 5:22 PM on July 20, 2018 [1 favorite]

I'm an emergency physician/toxicologist.

Existing treatments for marijuana dependence are largely ineffective. Reviews of current, "best practice," social/psychotherapuetic interventions (e.g.cognitive behavioral therapy, motivational enhancement therapy, 12 step programs, in-patient treatment centers etc) indicate that around 50% of patients relapse within 3 months, and 85% of patients relapse within 6 months.

The key takeaway here is less that people try but mostly fail to help those with marijuana dependence, and more that "kicking the habit" almost always takes several tries. You can think of it this way: your brother needs to repeat treatment until he becomes one of the 15% of patients that stay clean for more than 6 months

And that's probably going to take much, much longer than you would like, if it happens at all. Making allowance for this is essential for your own well-being.
posted by BadgerDoctor at 5:27 PM on July 20, 2018 [12 favorites]

don't assume that his problem is pot, or that in the absence of pot he won't have the same problems.

If you want to help your brother, try to work with him to evaluate his day to day issues, and long term goals.

Once you have an idea of what problems he is self medicating for, offer support and alternatives to being high.

The best way to help someone is to offer them a better path forward. Of course you will need really need to be able to trust each other if you try this.

So even if you can't stop yourself from being judgemental, do your best to be frank and fair, and actually listen. Don't try to convince him that you understand his problems better than he does, or know what is best for him better than he does.
posted by KBGB at 6:15 PM on July 20, 2018 [5 favorites]

What are his overall goals? What does he want to do with his life? What does he want his adult life to look like? A job? An apartment? A partner? Living with his parents? Moving out? Traveling? Living in his current city? It may be helpful to shift the conversation away from "Stop doing this thing that's helping you" toward "What do you want to be doing and how can you start focusing on that?" (Note that this really only works if the goals are his own, and if he is the one (with support) generating ideas for how to attain them.)

And I'll echo others in saying that if he does want substance-use-disorder treatment, a dual-diagnosis program that addresses both mental health and substance use would likely be more helpful than a straight substance-use program.
posted by lazuli at 6:19 PM on July 20, 2018 [3 favorites]

Nthing MJ is not the problem and that he is self-medicating something serious that requires professional diagnosis and treatment.
posted by jbenben at 6:28 PM on July 20, 2018 [3 favorites]

MJ-associated Cyclical Vomiting Syndrome
Cannabinoid Hyperemesis Syndrome is a clinical diagnosis. Does your brother habitually take a lot of hot baths to ease his pain and nausea? Is the pain a 9-10 on the pain scale requiring emergency room visits? There's usually a great deal of screaming and dry heaving involved.

Everything you've said is tragic and I'm sorry it's happening to your family. Aside from the possibility of CHS, nothing you've said strikes me as out of character for a person with mental health issues who is addicted to a substance, regardless of what that substance is.

Are you getting therapy? Is your mom? Family members of addicts need help, too.
posted by Revvy at 8:44 PM on July 20, 2018 [1 favorite]

Nthing what valannc, ersatzhuman, and others have said. You cannot help your brother unless he wants help. While I am not religious nor spiritual, I have found Al-Anon super helpful for learning how to take care of myself, set and hold appropriate boundaries, and stop focusing so exhaustively on the addicts and alcoholics in my life.
posted by Bella Donna at 1:39 AM on July 21, 2018

Marijuana is known to have a negative impact on adolescent brain development, to the point of bringing latent tendencies toward mental disorders into actuality. It sure does have to do with the MJ, and in fact the MJ is probably responsible for his anxiety.

Agreed that family therapy and Al-anon would be the best course, so that the family can learn the best way to deal with this.

I dunno. He’s 20 years old, steals, lies, and creates major issues for the rest of the family. I would offer him a choice that he either enters rehab and therapy or he has 30 days to move out.
posted by Autumnheart at 7:53 AM on July 21, 2018 [3 favorites]

You may not be able to help him right now. I'm sorry; it's very hard to see someone you love wrecking their life, jeopardizing their health and future this way.

You can help your Mom. She can keep jewelry and anything else pawn-able with you or another person outside the house, and it should be locked up. She should severely limit the cash she keeps on hand, and keep all credit cards and ATM PINs super-secure. As long a she can live with her, he has no incentive to change - he has room and board and his buddy gives him weed.

You and your Mom can go to Alanon, NAMI or other support meetings.

I wish you the very best.
posted by theora55 at 9:13 AM on July 21, 2018

-He is dealing with extreme depression and anxiety and is getting seen by a psychiatrist. He is prescribed sertraline, propanolol, and recently klonopin in a bid to get him to use MJ less. His psych knows all about his situation and is actively treating him.

This doesn't sound to me like he's necessarily addicted to weed in particular so much as that he has a serious anxiety and depression disorder, which you already KNOW. Everything else about this is in fact exactly the sort of difficulty with work and life that one would expect of a serious anxiety and depression problem. I didn't manage college until my early 20s, and I didn't manage reliable paying work until my 30s, and I've never touched the stuff. I'm still okay now. You need to accept that he is not going to be magically okay if he gets off The Drugs, here. You say that his anxiety is debilitating and real but then act like "getting treatment" should mean that without the marijuana he's okay, and it doesn't work like that. SSRIs sometimes even make the anxiety side worse for the sake of making the depression better, and the propanalol and benzos only help you survive the moment.

I'm not saying he should still be doing it, but you need to spend some time getting used to the fact that this is what "normal" looks like with serious mental health problems, and that this isn't just something where removing one substance from the equation is going to make everything better again. Learning to cope with emotions is one part of depression and anxiety treatment, but your writing here is incredibly dismissive and disrespectful of the impact these sorts of problems have on people. I lost a bipolar friend to opiate abuse--the opiate abuse was a problem, but another problem was the way everybody around him expected him to be fine once he was clean, and he wasn't, he'd never been fine and that's why he relapsed and overdosed.

Your brother may have a drug problem, but he has a serious mental health condition first and you need to work on how you support the brother you have, not the brother you think you might have had if he'd made different choices.
posted by Sequence at 9:11 PM on July 21, 2018 [5 favorites]

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