I am drawn to difficult jobs that help people. Starting at age 12, I volunteered at nursing homes, homeless shelters, residential programs for children with various challenges, and adult prisons. In college, I noticed a gap in services for youth leaving the foster care system, which inspired me to open a group home with ancillary services to prepare these high-risk young men for productive lives as adults. I loved every minute of facing resistant teenagers and trying to motivate them to make better choices.
Years later, I found a new calling — supporting individuals and families with behavioral health challenges, specifically addiction, mental health, eating disorders, and autism spectrum disorder. I don’t need to list the statistics supporting this work; you can’t pick up a mainstream publication without reading about the opioid crisis, rising rates of recreational marijuana use, increasing rates of depression and anxiety, and higher incidence rates of autism spectrum disorder. There were two major motion pictures released this month on the topic of addiction.
We field calls every day from family members trying to navigate fragmented systems, force unwilling loved ones into treatment, manage challenging family dynamics, and keep the process “discreet” for fear of tarnishing the family’s reputation. Even for the most successful among us, it is easy to become paralyzed when confronting these issues. When discussing his attempts to get his resistant young adult daughter into residential treatment, one of our clients said, “I run a business empire and I can’t fix this.”
I had my own brother, Chris, to fix. There is no one who represents resistance better than him. We grew up in the suburbs of Boston with my parents and my other brother, Matt. Our childhood was idyllic — private schools, skiing on weekends, trips to the Caribbean, and two doting parents supported by a large, warm extended family. We do come from a family genetically predisposed to addiction; my dad is 30-some years in recovery and has multiple family members with similar struggles and successes.
Chris started his journey with substances in the way most children do, experimenting with alcohol and pot, but he started early, probably around 12 years old. His using progressed; he wound up an IV heroin user who dropped out of Georgetown and spent over a year in Orange County Jail. Despite the consequences of his use, all of the money spent, and the emotional turmoil he caused, we stayed routed for years in the same patterns. Mom, like our client, obsessed about fixing the situation. My brother wouldn’t talk about it. I tried to save him by begging him to go into treatment and my Dad gave him money when he called. Chris went through 15 long-term residential facilities, 30 different clinical professionals, 25 different medications, and we even flew a lawyer across the country to help him avoid a lengthy prison sentence.
It wasn’t until a dramatic relapse where Matt and I headed to Harlem to pick up Chris at a drug dealer’s house that things started to change. Chris’ addiction psychiatrist brought us in for a family meeting where he said, “You better be prepared for him to die. He is one of the worst addicts that I’ve worked with; he has no sense of self or regard for consequences of his behavior.” During that meeting, we didn’t strategize on which place Chris might like to go to or how to get him engaged in a career that he would value. We shared the impact his behavior was having on each of us. Mom said she wasn’t going to watch Dad ruin his last remaining years with panic attacks and a lack of sleep. Matt said there wasn’t enough oxygen in the room for him; he couldn’t share his own journey into recovery or the joys of being a new dad because we were all obsessed with Chris.
I can’t say that day ended and Chris started a linear journey to recovery. What did happen, however, is that we questioned ourselves on how we were reacting to Chris’ choices. The focus became less about cajoling Chris into recovery but instead about what boundaries we were willing to uphold. Dad decided to write Chris a letter; he told him that he didn’t want to talk with him until he was six months sober. We chose a program for Chris that was a cost-effective option (we’d previously encouraged “nice” programs, those with warm weather so he could enjoy the experience). We made a game plan of what we would do if Chris were to refuse to go into treatment.
That meeting fundamentally shifted our family dynamic. There are a variety of factors that helped us to stop resisting and start accepting our reality. As they say in AA, we were sick and tired of being sick and tired. We also had an objective professional holding up a mirror, giving us data of how out of control the situation was. The interesting part about behavioral health issues is that many times, family members are as resistant to changing their dynamics as the individual is to adjusting his or her behavior.
Chris’ story begs the question, “What is the answer?” I’m sure it’s the question you have and it is the question that every client asks. While I don’t have a magic formula, I do some learnings that I think are worth sharing. In an attempt to simplify an incredibly nuanced and complicated topic, I have created a Top 11 Tips List:
- Openly discuss genetic predisposition towards mental illness or addiction — be honest about your family’s strengths and vulnerabilities.
- Identify and address signs of a behavioral health issue swiftly.
- If a loved one is resistant to care, set small boundaries and stick to them until they become willing. Consider an intervention.
- Find a team of qualified professionals to make diagnoses, outline a care plan, make recommendations for inpatient or outpatient treatment, and monitor progress.
- Assume that your loved one will need therapeutic support and accountability over the long-term (i.e. one to five years) .
- Advocate for your loved one — question providers when uncertain about course of action and get a second opinion.
- Proactively manage privacy releases: HIPAA, healthcare proxy, college grades.
- Engage in family treatment and self-care of some form that includes siblings and children.
- Use crises as opportunities.
- Create a reasonable plan for financial support with educated professionals.
- Grieve the loss of your dreams for your loved ones . Try to accept that your loved one may live a different life than you envisioned, but it won’t necessarily be a lesser one.
We took some of the advice above and Chris managed to achieve sobriety, graduate college, get his master’s degree, and fall in love. He created a podcast called “Dopey” that attracted and continues to attract thousands of listeners with an irreverence and humor that bespoke his nature.
However Chris’ story does not have the happy ending for which we’d all hoped. After four and a half years of sobriety, Chris fell back into the troughs of his addiction after suffering a physical injury. He passed away this summer from an overdose. One of the hardest parts for me was accepting that even as a professional in the industry, I could not save him or my family from the enormous pain.
When I wrote his eulogy, his friends and podcast followers poured in with comments talking about how much he had helped them, how he had saved their lives, how he felt like a friend despite the fact they had only heard his voice on the podcast. Chris didn’t live a lesser life because of his addiction — he lived a short but big one.
Last year, Chris wrote an article for the Elephant Journal. In it, he said, “Like most people, I would like to leave a legacy — something that extends beyond my years and changes the world for the better. Traditionally, I’ve hoped my stamp on the world would be concrete: a company, a book, whatever. But I have this unshakable feeling that the best thing I could ever do is to be available and kind to the people I interact with on a daily basis.” He did just that and I am honored to be his sister and continue to help families with the lessons he taught me.
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