When the party's over... getting help for addiction
Christmas can throw a harsh light on addiction and many families will now be dealing with the realisation that a loved one may have a problem. We talked to the experts for advice on staging interventions and taking that next step
Addiction treatment centres often experience a spike in admittances in January and February. At first glance, it looks like this trend is part of the new year resolution rush. On closer inspection, however, it shows that Christmas is crunch time for those struggling with addiction.
Yes, January is the month to implement change, but the festive season - and its many temptations - is very often the tipping point for addicts.
Reasons vary. In some cases, the addict begins to neglect their duties at a time when all hands should be on deck. In other cases, the pressure builds to the point that 'a few home truths' are brought to light over Christmas pudding.
There is also the theory that family members that may normally be separated by large distances or demanding schedules are in each other's company for extended periods, and they may observe behaviour that they can no longer ignore.
Either way, there is generally an initial period of quiet concern. "The reaction is typically to ignore the first signs and the second signs," says addiction counsellor and former Offaly football manager, Gerry Cooney of the Rutland Centre in Dublin.
"It takes a lot of time and energy before people finally gather themselves to intervene when somebody they care about is struggling with alcohol or any substance. Very rarely would somebody come forward themselves and ask for help. It is almost always as a consequence of a family intervention."
The word 'intervention' is not without its connotations, though. Many deride it as an overblown American import, or worse, a reality TV concept. It doesn't help that the verb 'stage' is often appended to it.
"I think we have to find a better word," agrees Cooney. "It sounds very cold, calculated and clinical. You're just showing concern for somebody, and that can mean the same thing."
So what kind of behaviour warrants an intervention?
"Anything that is different," begins Cooney. "Anything that has changed. Anybody at risk. Anybody impacting on a relationship. Anybody neglecting their children. Anybody getting into a car with drink taken. Any kind of crisis.
"Somebody changing their own rules," continues Cooney. "Some part of them knows this and they struggle with it to some degree. It suggests that they are losing control.
"You can generally see these signs, even though you might ignore them. However, when you see something that makes you feel uncomfortable, something should be done sooner rather than later."
Conventional wisdom tells us that an addict has to reach 'rock bottom' before they can be helped. Cooney disagrees. "I would really question that," he says. "There is this belief that you can't do it for a person. Yes, you can't make a person do what they don't want to do, but you can reflect back to them what's happening."
Cooney's foremost advice to families at this stage is the need for an "agreed, measured, consistent response". "That generally moves the situation forward," he adds.
"What typically happens is that family members or friends come at it from different angles and you have some people challenging, some people covering up, some people ignoring."
This brings us to the subject of enabling, which Cooney says is much more common than people realise.
"A lot of people end up accommodating, facilitating or enabling someone to drink or use substances and it delays change and prevents somebody who needs help from getting help.
"However, it's not a criticism," he adds. "I think everyone does it. Parents do it because they think they've failed their sons or daughters.
"If my daughter is drinking excessively, what does it say about me? If a partner is drinking or using drugs, the first reaction is usually 'Am I the problem? Would he be happy with somebody else?'
"People enable - despite themselves - because it reflects on them in some way."
In other cases, they may avoid passing judgement for fear of being judged themselves. "We have friends coming into the Rutland sometimes (a Concerned Persons Day is part of the programme) and they say 'Who am I to talk? I drink more than I should sometimes'.
"But I suppose, again, that's the challenge for everyone individually to look at their relationship with alcohol and how it affects them."
Defensiveness is to be expected during an intervention, continues Cooney. "The nature of the beast is that people tend to be quite defensive, quite angry and quite hostile to the suggestion that they're losing control."
He also notes that attack can be the first line of defence for the person being challenged. "They might respond with 'Who are you to say? Sure, we're all doing the same thing'."
Sulking is common too. "There can be a cool in relationships sometimes. You can be punished for daring to suggest that somebody is crossing a line. They are all familiar responses because, again, they are coming from a fearful place - a place of denial."
Interestingly, this attitude can persist all the way to the door of the treatment centre. "Very few people are coming forward with their hands up saying 'help me, please'," notes Cooney. "Most people are coming in saying 'I still don't think it's that bad'."
When it comes to numbers, Cooney believes in keeping it small. "Generally you don't want to overkill.
"Ideally, it would be three or four people who the person is most likely to listen to and to hear. Otherwise, it might seem like people are ganging up on them. They should all bring their own experience rather than repeating the same thing."
He also advises that certain family members shouldn't be present. "A sister that the person might not have a great relationship with might not be the best person to be there."
The language and tone used during an intervention is equally important. "There is no point saying 'you're always drinking'," he explains. "That only invites the response 'I'm not always drinking'.
"You need to bring very real, factual, practical incidents of when you were in this person's company and you went away concerned. That's something that the person can't argue with. You are just sharing facts."
Instead of generalisations like 'always' and 'never', Cooney suggests statements like: 'This is what I'm seeing... This is different. We used to have fun. Now I have to look out for you on a night out. I have to make sure you get home safely and that takes from my night out.'
"It's just reflecting back real, actual incidents," he adds.
Cooney advises families not to discuss the possibility of a recovery centre at this point. "I say to people, 'if you can encourage your son/daughter/wife/husband to come and talk to me, I'll take it to the next stage'. You're not asking them to agree to commit to treatment. You're just asking them to agree to go and talk to somebody."
If the issue is alcohol, to what degree should a family shield their loved one from temptation in the meantime?
"As long as you're not flaunting it and having late-night parties when the person is in the very early stages of change, well then there is no reason why you shouldn't be able to have a couple of drinks yourself," he says.
"It's not generally recommended that you get rid of every drop of alcohol from the house. You try to be as normal about it as possible and, generally, people who are trying to change would prefer that approach.
"Sometimes the person who has decided to stop would prefer that the people around them are normal and not afraid to mention the 'a' word. But sometimes people choose to stop because they want to be more supportive to a family member.
"If you think you can stop the person drinking, you won't. If they want to get drink, they'll get drink, whether you have a bottle of wine in the house or not."
We often think that we can help a loved one by closely monitoring their whereabouts, daily intake and everything in between. Unfortunately we are only fooling ourselves.
When abuse has progressed to dependence, an intervention is crucial, even if the suggestion initially falls on deaf ears.
"Remember, even if the person doesn't respond in the way that you would like, you sow a seed and the person goes away and thinks about it at some stage," says Cooney.
"So even if it doesn't go as well as you hoped, it brings the day forward when the person will come and ask for help. I'm sure of that."
* For more information, see rutlandcentre.ie
The cost of recovery
The HSE offers many residential addiction recovery facilities for drug treatment, as well as non-residential options for alcohol addiction. Costs vary but most programmes are covered by a medical card. See citizensinformation.ie for more information.
Registered charity Cuan Mhuire, which has centres across Ireland, offers a longer residential programme and takes a portion of the patient's social welfare payment each week to go towards maintenance; see cuanmhuire.ie for more information.
Private recovery facilities in Ireland can be expensive. However, they are covered by most private health insurance policies.
The Rutland Centre takes clients covered by Aviva, Laya, GloHealth and VHI Healthcare. Most of these health insurance providers cover 90 days of residential treatment. The Rutland Cente programme is 35 days long; see rutlandcentre.ie for more information.
Health & Living