My mother was drunk before eight o’clock this morning. Her voice on the phone sounded contrite, but her tells were there: slurred speech and repeated phrases like, “Yeah,” and “You’re not OK, are you?”
I cut our pre-breakfast conversation short because I am unwilling to participate in our relationship while she is under the influence. Unfortunately, this has been the state of things between us since I got sober and she refused to get professional help.
It’s hard enough to know when to offer someone assistance, but it’s even more complicated when that person doesn’t want or believe she needs help, and she is a family member, or any person for whom you care deeply and want a healthy life. And so, one of the most common questions regarding addiction is: “At what point do I speak up, and how do I get someone to accept help?” Then, the two natural follow-up questions are: “What does help look like?” and “At what point am I unable to help any longer?”
Just as each addict must reach a bottom that is personal to her, he who loves the addict must reach a bottom that is personal to him. There are no set instructions that detail when it’s time to cry, “Enough is enough!” By the simple nature of systematic desensitization, each offense the addict commits becomes easier to swallow for the one who loves her. As the addict continues down the seemingly endless spiral of addiction, it is up to the individual to decide when to let go of her hand. However, whether it is early or late in the game of loving an addict, I’ve found two lists to be important tools. The first list details concepts that would qualify as what I call hypothetical deal breakers: stealing, lying, cheating, overdosing, prostituting, and the like. I made the first list using my personal moral compass, the part of me that is unattached to anything other than what I believe to be the right way to live. The second list details events that I have experienced, described in a non-judgmental way. I hold the two lists next to one another and see how they align. I ask myself, What hypothetical deal breakers have I violated?
It’s important to remember that each list is about me and how I have changed since addiction came into my and my mother’s life. The dual list idea tries to gauge how far I am willing to go with her, and serves as an unbiased, non-shaming look at my own behavior. As addiction is said to be a family disease, we are all complicit in furthering its destructive potential. It won’t do any good for my addicted loved one to read this painful review of my life, and it won’t inspire her to get help. Disposing of the list is wildly important, and for me, burning the list feels best.
As with everything related to addiction, the decision to get help is up to the addict. In order to accept help, a change of mind is necessary. This step is often frightening for addicts, most of whom suffer from abandonment and defiance of authority issues. And change is difficult for everyone.
Ultimatums, or coercion, imply an absence of autonomy and remove the addict’s choice. Unless you are a court official, probation officer, employer, or sports organization, coercing an individual into treatment is difficult. Coercion can ignite counter-will, a term coined by psychoanalyst Otto Rank that describes our natural inclination to do the opposite of what we are being coerced to do. And so, an addict may manifest a rigid defense. Currently, 42 states allow some form of involuntary commitment into an outpatient program, a mental health law referred to as AOT, or Assisted Outpatient Treatment. AOT is court ordered and an addict qualifies for involuntary commitment if she meets certain criteria, predominantly if she is a threat to herself and unlikely to survive without treatment.
Statistically, individuals who have been coerced and went into treatment stayed clean longer than those who were not coerced, and did not go into treatment. In a study by Polcin and Weisner, a whopping 40 percent of individuals entering into a treatment program had received some form of ultimatum, either from a loved one, court, or healthcare professional. And yet, questions regarding the ethics of forced treatment are relevant and carry great weight.
Bribes don’t work and often reinforce the addict’s behavior. Behavioral psychology explores how stimuli can be conditioned to elicit desired responses. Think of a rat in a cage: the rat accidentally pushes the lever and receives a food pellet. The pellet is a delicious and tasty little rat-reinforcer, and within no time, the rat will be conditioned to push the lever to get the food pellet. So what’s wrong with that? Continuous reinforcement, like a lever that immediately and consistently delivers delicious and tasty rat pellets, becomes extinct easily. This means that, if the rat is given a pellet every time he pushes the lever, soon after pellets are not offered as a reward, he will quit pushing the lever. Interestingly, recent studies on motivation and learning have shown that giving children extrinsic rewards (like money) for good marks in school only creates good grades in the short term. Just like the rat, when kids lose their reward, their grades decline. It’s likely that rewarding the addict for sobriety will work in the same way.
Sometimes watching and waiting for a change isn’t effective either. When we wish our loved one to be someone other than who she is, our resentment grows, and hope and faith wither. This can disintegrate any kind of meaningful relationships that existed. And perhaps even more importantly, additional loss and tragedy can occur.
So we have to do something, right? A more modern approach to inspiring change in addicts is the harm-reduction movement, in which it’s not suggested that “change” is necessary at all, and the model of helping looks entirely different from what most abstinence supporters call sobriety. Though harm reduction is controversial, the work is profoundly human in that it strives to offer the addict acceptance. It suggests that addiction looks like a spectrum disorder (with varying shades of addiction), as opposed to a more traditional disease model (people are addicted or not). It recognizes there are safer ways to use drugs. Harm reduction helps the addict to maintain her dignity, and instead of insisting upon sobriety or abstinence, works to lessen the potential harm an addict will incur. By offering support, compassion, understanding, and empathy, harm reductionists provide the solid foundation upon which an addict can empower herself. That’s all great for the addict, but to be a harm-reduction caregiver requires serious boundary maintenance and attentive self-care, perhaps even more so than for a traditional disease-model caregiver.
I guess I fall somewhere in between the two approaches. Accepting her choice is said to be the answer to all my problems, yet I continue to lose all hope every time I hear my mother’s slurred speech. Abstinence sobriety works for me, and being a sober woman, I’ve had to create healthy distance in our relationship. The distance helps me accept the life she is choosing to live. Until we are too close and then the false need arises within me for her to quit drinking. It’s a false need because it means I need her to be someone other than the woman she is. Also, it isn’t healthy for me to listen to her while she is intoxicated because I begin to resent her and hate addiction. The last thing I need is to be resentful and hateful of my genetic makeup.
These are all issues that came out on my lists, and because I am unwilling to cut her out of my life entirely, I have to hold a bottom line for behaviors of hers that I will not reinforce. So I continue to wait for her to decide for herself that her drinking no longer works, a decision that would hopefully coincide with a request for help. I will be there when, and if, she does. But, to be honest, the waiting feels a lot like giving up. It feels like I’m watching her die, because I have accepted that until she asks for help, I am unable to help her. And the truth is, I want to save my mom. I just know it’s not possible, just like it wasn’t possible for anyone to save me. I was able to save myself with help, is the repeating thought that brings all of my hopes for her back to life. My biggest hope is that, one day, she will be able to ask for and receive help too.