Synopsis: People who use drugs, even those who are not addicted, are often destructively enabled by families. An expert explains why this occurs and what families have to do to break through their own denial as well as that of the user.
Host: Nancy Benson. Guest: Dr. Wesley Boyd, Assistant Clinical Professor of Psychiatry, Harvard Medical School, and author, Almost Addicted.
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Nancy Benson: We live in a stressful world, and a lot of people need a little something to get through it. For some, it’s alcohol. For others, it’s drugs. Maybe they keep their use under control most of the time. But when a little extra stress arrives, they start using a lot more. But family members are often the last to know.
Boyd: People can be very good at concealing drug use, so it’s not uncommon at all that people in families are not aware that their family members are using drugs.
Benson: That’s Dr. Wesley Boyd, Assistant Clinical Professor of Psychiatry at the Harvard Medical School, and author of the book, Almost Addicted.
Boyd: I certainly see parents, spouses and siblings every day in my psychiatric work who either don’t know about the drug use by the loved one, or don’t know the extent of it. So sometimes we’ll get a history from a parent of an adolescent and the parent will say, “yeah I think my son or daughter used marijuana a couple of times and maybe something else,” and then you get the child in a room separately and the story can be one of dramatic substance use.
Benson: However, doctors can be fooled, too.
Boyd: Almost addiction does not rise to a diagnostic level because it’s not by definition going to be in your face the way more full on addiction or even abuse is going to be. It definitely does get missed a lot by the medical profession. Primary care doctors, who I have the utmost respect for, are almost to a person dramatically overworked, and because of that it’s going to be very easy to miss something if it is not in your face.
Benson: Drug use in someone with a mental illness becomes much more complicated. And more common. Boyd says research shows that people with mental health conditions, such as depression, anxiety, or post-traumatic stress, are more likely to engage in substance abuse.
Boyd: And not surprisingly, conversely, people who use substances are more likely than those who don’t to have various mental health diagnoses. As a clinician, I can say often it is very hard and sometimes simply impossible to tease apart which one came first, which one might have contributed to the other. Sometimes you have to go back and see whether or not someone had a mental health condition prior to ever using drugs in the first place; that can certainly clarify things. So, for example, if someone had depression long before they started using depressive substances like alcohol or marijuana or other downers, then you certainly might think the depression was pre-existing and might have contributed to substance use, but the substance use didn’t cause the depression.
Benson: Substance abuse short of addiction can obviously cause other problems as well. Many people may go for weeks between usage. But every now and then they may drop a family obligation, turn in poor quality work, or not show up for work at all. And sometimes, families are well aware what’s going on.
Boyd: It is also unfortunately not uncommon for family members to know about drug use and either downplay the extent of the drug use, downplay the extent of the problems caused by the drug use, or even, as we say in psychiatry, enable the behavior. What enabling means is to actually make it easier and/or more possible for the person to continue using drugs. So, enabling behaviors might be making excuses for why someone seems a little under the weather when you know full well that, in fact, they’re not feeling well because they’re either high or coming off of a bender or something like that.
Benson: Unfortunately, families may be just as good as drug users themselves at denial. Some of the reasons are practical — family members may fear that exposing a drug habit may cost the family breadwinner his job. Denial can also result from love.
Boyd: It might make it almost impossible for them to see any foible or problem in that loved one. I’ve told people many times, this doesn’t really pertain to substance use per se, but it certainly could — my mother, who thinks that I’m otherwise a pretty decent and kind person, I would assume that if she saw me shoot somebody point blank right in front of her, that in a matter of several minutes she would be able to convince herself that, in fact, I had not done any such thing. And I think that speaks to the extent to which we see what we want to see. It’s very hard to see things that might be painful or difficult, especially when they apply to loved ones.
Benson: Boyd says getting families to stop enabling a drug user is one of the first steps to actually solving the problem. Then they need to start a dialogue with the drug user.
Boyd: The key is to really try to stick to facts that are more or less indisputable as opposed to judgment type statements, which can be disputed. So, for example, instead of saying, “I think you’ve got a problem with drugs,” I encourage family members to say, “You didn’t show up until four o’clock for the two o’clock wedding last week, and you did get pulled over by the police officer doing fifteen miles over the speed limit and you were slurring your words.” So, try to take the facts and try to keep emotions out of it. I realize that if family members have been burned by someone’s problematic drug use, it’s easier to say try to keep the emotions out of it and stick to the facts than it is to actually do that.
Benson: Boyd says families need to apply whatever leverage they have to encourage their loved one to stop using. With adolescents, he suggests parents apply what he calls “the seven C’s,”
Boyd: “The seven C’s” are credit card, that’s two C’s, cash, car, computer, cell phone, and curfew. Often with adolescents you can leverage them into different kinds of behavior by withholding or using some of these points of leverage to try to get them to do what’s really in their own best interest ultimately.
Benson: However, Boyd says in Colorado and Washington, the voters have just made things harder by approving legalized recreational marijuana use.
Boyd: Marijuana even used at low levels increases one’s risk for all kinds of psychiatric conditions. One study that we quote in the book, for example, says that if you’ve smoked marijuana less than ten times as an adolescent your risk for developing schizophrenia goes up by over fifty percent. If you’ve smoke marijuana more than fifty times as an adolescent your risk for developing schizophrenia goes up six or seven hundred percent.
Benson: Boyd’s book, Almost Addicted, provides tools to identify if drug use is a problem in a loved one, or yourself, and what to do to keep it from getting worse. You can find out more about the book online at thealmosteffect.com, or through a link on our website, radiohealthjournal.net. Our production director is Sean Waldron. I’m Nancy Benson.