Tuesday, November 11, 2008

Holding On Versus Letting Go A Painful Treatment Dilemma

Often, when working with families with young people in treatment for alcohol and/or substance abuse, there comes a time when parents must choose a path with the young person that can be a painful one.  A fork in the road appears when the young person has not yet made a full commitment to sobriety and a decision needs to be made about how to respond.  This is particularly difficult when it is time for the young person to come home.

The normal path of separation between parent and young adult comes naturally and slowly, over a period of time, as the young person prepares to either move away from home or go off to college.  There are often struggles and strains connected with this time but usually both parents and their son or daughter get through it with a but a few lumps and bruises and life goes on.  Inherent in this developmental path is the understanding on the part of the parent that, even though they may not see their child as being ready to face "reality", they are nevertheless confident, that with a little help and support, they will make their way.  Also, a connection usually remains in the form of letters, emails, visits on the holidays, and requests for more money etc.

However, there is another path that parents can face when their youngster is not committed either to treatment or, after going through treatment, is not willing to commit to sobriety.  Here, the decision becomes one of whether to continue to remain in relationship with, and provide support for them, or letting go and allowing the young person to face their addiction first hand by having to take responsibility for their choices. This often means having to say, "I'm sorry but you are on your own.  We will not support your addiction.  When you are ready to commit to your sobriety you are welcome home"

Here is a much different letting go than the normal developmental path described above and a much more painful one.  It is here when a parent's imagination may only be able to see the young person as living on the street, getting deeper into drugs, or, worse yet, dying of an overdose.  These are all very real outcomes but not the only ones.  Many times the young person needs to first recognize that they can no longer manipulate their parents into providing support while they do drugs before they are willing to make that commitment.

There are no guarantees here in terms of making the right decision but there is sufficient evidence to suggest that the best decision is to let them go.  The "best" decision however does not stave off the pain that a parent has to feel or the dreams that they may have to say goodbye to: dreams of a happy healthy young person heading off into life. 

This dilemma is often complicated by the fact that it seems counter to their expectations about what the outcome of treatment would be.  The expectation is usually that the young will come out of treatment fixed and drug free.  However, treatment and the stages of recovery do not necessarily flow in a nice linear path.  Many young people come out of treatment having learned a great deal and having grown a lot but may still not be ready to give up substance use.  Success in treatment may not be measured by the end of treatment outcomes but rather by an eventual path impossible to see by the parent. 

When faced with the decision associated with the latter form of letting go, one can only say to a parent, "have faith, rest in the support of those close to you, fall back on your spirituality, know that there is more to come and the possibility remains that you will be able to, at some later time, return to that fork in the road and take the path that you had hoped for. 
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