When your adult child is dealing with opioid addiction, it’s no time to be their friend.
By Krystyna Vaccarelli, LCSW, LCADC Trinitas Regional Medical Center
When a public health issue becomes a crisis, and then goes from being a crisis to an epidemic, it is human nature to look for a “magic wand” solution. What switch, we wonder, can be flipped to turn back the clock, return the genie to the bottle, to make everything manageable again? If we are talking about the opioid epidemic, unfortunately, there is no magic wand. And no one is immune, either.
As the Director of the Substance Abuse Services at Trinitas Regional Medical Center, I know that there is no way to characterize that next person coming through our doors. It could be a 19-year-old who grew up in an environment of drug use, or a soccer mom from Short Hills who rolls into Paterson to buy heroin because the addiction has consumed her and the cost of illegal prescription pills is beyond her means. Socioeconomics plays no favorites where addiction is concerned; we’ve seen plenty of both. In fact, I can say with a high degree of certainty someone you know very well—but might never suspect—is in this predicament right now. The horrible piece of opioid addiction is that it is really easy for people to medication once your prescription has run out.
Everyone we see in the Substance Abuse program is somebody’s son or daughter. So what if that next person is your child? If you are concerned that your child might become addicted to medication—and really, every parent should be—there are some common-sense things you can do. For children who are minors, parents should accompany them into the examination room and be part of the conversation during any doctor’s visit. Ask what the minimum amount of medication is that will be needed to treat a condition—not just opioids, but anything that could have negative consequences down the road. Don’t just sit in the waiting area. If you are concerned about your adult child, remember that being an involved parent is important regardless of your child’s age. You may not be accompanying your kids to doctor’s appointments anymore, but they still need the structure, rules, expectations, and guidelines a parent provides. These are the foundational elements in setting them up as functioning adults.
I think a miscalculation many parents make is wanting to be a child’s friend once they hit those difficult ’tween and teen years. No one wants to be the bad guy and have to say No all the time, but does saying Yeah, Sure, Okay mean you love your kids more? That doesn’t make sense.
There will be time later on to be their friend.
Once a child moves away from home, of course, the nature of your contact changes. However, you can still see or hear things no one else but an involved parent would. If you notice a change, you don’t have to be afraid of acting. The sooner a parent intervenes, the better the outcome will be. Go with your gut if something doesn’t seem right, or if you have some questions you feel you should ask. Believe it or not, particularly if you have been an involved parent, contributing to the medical decision-making process shouldn’t strike your son or daughter as unusual. So you shouldn’t be timid about saying, “Wow, 30 pills? Doesn’t that seem excessive? Did you question your doctor about this prescription? Please be careful. It’s easy to become addicted—don’t go outside the prescription.” I believe that is reinforcing an aspect of the relationship that has been there all along. Indeed, it’s a product of the good groundwork you started when they were small children: being educated and aware. Now you are passing that education and awareness to your children as they become adults. Even if you don’t have that type of relationship, you can still say, “Hey, don’t listen to me if you don’t want to, but please get a second opinion.”
There is good research going on that is looking at people who might be more predisposed to becoming addicted to drugs than others—genetically predisposed, psychologically predisposed, perhaps a combination of both. That being said, we know quite a bit already from what we observe day-to-day in the Substance Abuse program. I cannot overstate how critical the family dynamic is in the big picture of the opioid epidemic—not just in recovery but also in the conditions that often surround addiction.
We see generations of addicts in the same family come through the program. It may be a physiological predisposition, but it might also be the culture or environment of the family. That’s the interesting question: Is it one or the other, or both? Most people would say that it’s the environment. However, we sometimes treat members from the same large family that are dispersed—they don’t interact with one another on a regular basis. And yet all of them are receiving some form of treatment, typically for mental health or substance abuse.
We also encounter a fair amount of fractured family situations in the patients we treat. That is why we offer family therapy, as well. A patient can come in and we will work with a parent or a spouse or a child as part of the program (everyone we treat must be at least 18, by the way). One of my frustrations is that we don’t get the level of involvement in this part of the program as I would like. Sometimes patients decline because they know that the family will provide a lot more information than they are willing to provide. Sometimes the family doesn’t want to come in. They have “compassion fatigue.” They are done emotionally, and maybe financially. The only upside is that maybe that’s a part of a patient’s rock-bottom, that they’ve lost everything and everyone, which means we can start building them up again.
A significant part of what we do at Trinitas is relapse prevention. We counsel people on techniques for dealing with everyday stress, how to be able to function without drugs. We teach them how to work through it, but it’s always a work in progress. Does anybody learn how to deal with absolutely everything? No, of course not. And that’s something else we teach our patients: You have to work your way through life’s challenges to the best of your ability. When someone completes the Substance Abuse Program, they leave with a toolbox for coping with the stresses and triggers that result in a relapse. Their job is to take the tools we’ve given them, and then use them as they need them.
The work we do here is face-to-face, both group and individual treatment. When you are talking to someone and looking them in the eye, it’s harder for them to walk away. You have a better ability to fully assess someone and pull all the information together. On the most basic level, say someone is sitting across from you and smells like alcohol. You’re going to know that. You wouldn’t know that if you were on the phone with them unless they were slurring badly. I do know that Trinitas is working on a telemedicine component. Is there a day coming when we will all be on screens in a circle talking to each other? Who knows? But human contact will always be vitally important. Our patients are vulnerable people looking for support. When someone is physically there for them, it means so much more. For that reason, we strongly advocate attending Alcoholics Anonymous and Narcotics Anonymous meetings, in addition to our program. AA and NA provide valuable support, too.
We interact with as many as 800 people a week in the Substance Abuse program. If that sounds like a lot, then you are still not appreciating the size and scope of the addiction problem out there. One of our strengths, I believe, is that each person who walks through the door is assessed and evaluated as an individual; because there is no typical person who seeks drug abuse treatment. Some are here for the first time. We have people we have seen 10 times or more. Sometimes we are the last place people went for treatment and they come back to update us on how they are doing. We get young and old—again, as long as someone is 18 or older we can provide treatment. We’ve seen it all. I don’t think there is anything that would surprise us.
For me, the job of Director is one I take personally. I call the people who come through this program “my patients”—because they are. I meet almost all of them when they begin the program. I am very much involved in the front-desk area during their intakes. I am one of the constants in this unit as far as the patients are concerned. They know who I am and I know who they are. We do clinical team meetings, where I absorb a lot of information about them and I am involved in the team decisions regarding each patient’s care. I run groups when needed. My job is to keep the program running at a high level, so it is different every day. But my role is always to support the clinicians and the patients throughout the process.
When I took this position at Trinitas, I felt in many respects that I was led here. I have worked in this field for many years and am very passionate about what I do. I believe that everybody deserves a fair chance and an opportunity. If you want it, we’re here for you.
Addiction In Women
Trinitas offers a Women’s Addiction Services Program, which is specific to women who have identified substance-abuse problems. In the program, patients learn how to deal with a wide range of women’s issues, as well as childhood trauma, anger management, and parenting challenges. The program has a small babysitting/childcare area with supervision for children 6 months to 12 years old, while their mothers are here seeking treatment. For more information, call (908) 994-7125.