What to do if we think our family member has a drug problem?

Sep 26, 2021

Intro: Welcome to the chronic hope institute podcast. The only podcast designed for the families of those who are struggling with addiction and codependency. If addiction has rocked your household, and you don't know where to turn to get support, then this podcast was built for you.

Our host has written the book on how families can navigate the scary world of addiction, chronic hope: parenting the addicted child, and chronic hope: families and addiction, can both be found on Amazon today.

We invite you to connect with us on Facebook, as well as subscribing to the chronic hope institute podcast on YouTube, Spotify, Apple, or wherever you listen to podcasts. Now here is your host author, therapist, and CEO of the chronic hope institute Kevin Peterson. 

Kevin P.: Hey everybody, thanks for tuning in today at the chronic hope podcast on Monday, September 20th, 2021. And we are really excited today to have an amazing guest to talk about detox etc.

His name is Steve Carlton, which I've had a little fun with trying to beat into my head because it was Carlton, Carrollton, Carlton, Carrollton, and I just sat there and repeated his name backward and forwards. Steve, how are you today? 

Steve C.: Doing great, it's so good to be with you.

Kevin P.: Hey man, thanks for joining us; we really appreciate you here. And what we want to talk about today is what do we do if we think one of our family members has a drug or alcohol problem.

But before we go down on that path, would you mind giving us a little bit of background about sort of who you are, where you come from, what you do, etc.

Steve C.: Absolutely. Yes, I'm Steve Carlton; I'm the executive clinical director at Gallus Detox or a medical drug and alcohol detox facility. A little bit about my background, in addition to Gallus, I'm also a professor in the graduate school of social work at the University of Denver.

And prior to my experience at Gallus, I spent ten years treating addiction and trauma with veterans at the department of veteran affairs.

And prior to that, I was doing in-home family therapy with, actually with court-ordered families with an identified substance use problem. So yes, that's a little bit about me.

Kevin P.: Wow, that last part I didn't know, you and I share that together. I did that too; that's my first job at a graduate school, was working for Arapahoe Douglas mental health on the crisis response team.

And part of that program was going into the homes, and doing work in the homes, which was amazing, absolutely incredible.

Steve C.: Yes, it's fantastic work.

Kevin P.: Yes. And I think I'm sure you and I probably feel exactly the same way, in this sense that if you really want to impact change in the family system and in the individual, you got to get into where they live, not have them come to you once every two weeks.

Steve C.: Going to them, take that access problem away from them

Kevin P.: Exactly, remove the obstacles, exactly. All right, so today's topic is what do we do if we think one of our family members has a drug or alcohol problem. And in my books, I have sort of prescribed what we call plan a, which is we set boundaries, accountability, and structure in three categories, drugs and alcohol being the primary one.

And we try and hold the loved one accountable with love and empathy but still having boundaries. And drugs and alcohol, work or school, and then the final category is behavior at home.

And we give plan a generally about a 30-day run and see how it goes, depending on what it is they're using. But then, if that doesn't work, then we go straight to what we call plan b, which is intervention and treatment, and that's kind of where you come in. So let's say we do the intervention; at what point should someone be considering detox? 

Steve C.: I think detox is sort of the first step for a lot of people. And so I think you're considering detox when it becomes apparent that the drug and alcohol use, quitting on their own without support, is not going to be sustainable.

That withdrawals are commonly sweating, anxiety, cravings. Those are sort of the initial ones that people can't stop because those things become so overwhelming and uncomfortable. And so you would call detox and get them in with us. And from there, you identify next steps.


Kevin P.: And so if we have the family and the interventionist, and they're doing the intervention, and the intervention let's say goes well.

And I'm sure; I want our audience tends to be the family members of sort of like wondering what do we do and how do we do it, what's this going to look like.

Who makes that call? Is it the interventionist? They've identified a treatment center, and they call the treatment center. How do they decipher whether or not they should call you first?


Steve C.: Sure. I think when people have severe withdrawals, vomiting, diarrhea like they're really sweaty, they're sort of having those delirium trams if it's alcohol, we should be the first call. We know that withdrawals from substances are a lot of times the biggest barrier to people engaging.

There's so much fear around those symptoms that people don't want to go to treatment because they're terrified of how badly they're going to feel. And so we would be the first call on that end.

A lot of times residential facilities, if you start there, the admissions people will identify with the patient that the withdrawals are bad enough that they need to come to a place like Gallus and get that medical stabilization before they go on and can engage meaningful and in therapy and other interventions.


Kevin P.: Got you. So what I hear you saying is that so now I've done an intervention, and now I'm on the phone, and I'm calling my local treatment center, and I've gone through the insurance qualification process.

And now the admissions person that the treatment center is going to sort of walk me through, and get the severity concept, and then it becomes, they're going to help me find you.


Steve C.: The vast majority of the time, that is how it happens. For family, I think the message there is that they don't need to do that assessment work; you can leave that part to the experts.

And that really is our job and our admissions people's job, to ask those specific questions about whether or not detox is indicated.

When it is, it's usually pretty obvious that the withdrawals are really the barrier to somebody go into treatment because you're going to hear that from your family member or loved one.


Kevin P.: I know that in my client base, that tends to be one of the things that with someone who's using benzos or opiates or heroin or meth, methamphetamine that tends to be one of the biggest arguments against going to treatment is I'm not going to go through the withdrawal process.


Steve C.: Yes, exactly. And I think what Gallus does better than most is for opiates, in particular, the withdrawals, people feel like they're going to die, right? And if they've had treatment experiences and they've been that uncomfortable, there is some legitimate fear around.

Are these people going to treat me with dignity? Are they going to listen to me when I'm telling them I'm desperately sick? And in Gallus, we do listen to that, and we're proactive in how we detox people, so we make people much more comfortable than most, even through that really difficult process of detox.


Kevin P.: Actually, I'm not kidding, just last week that was one of the, I was on the phone with a woman, and the person that she was trying to talk into going to treatment, and that was exactly the argument from the young woman that was struggling with alcohol detox, was they're not going to treat me right.

I've gone to the ER before, I've gone through detox, I'm not going to have that stigma, I'm not going to have that shame attached to me, so I'm really glad that you brought that up, that's critical.


Steve C.: And I think a good question that family and the person struggling can ask is how do you all do detox? Is it proactive, right? Are you proactively staying ahead of those withdrawal symptoms? Or are you waiting until people get sick before you're medicating and helping them?


Kevin P.: Yes, that's a great question; I'm going to write that down; thanks, I appreciate that. So the next thing I get from families is okay, once we've introduced the concept of detox, then they come back at me, and they're asking me okay, so now I'm seeing things about a social detox and medical detox, and can you define those two and the differences and what you guys do at Gallus.


Steve C.: So I'll start with what's the same about social, and in medical detox, is it's usually designed to be an assessment phase, when you're coming into detox, you let the professionals and the experts at those places do that assessment and determine like what is going to be a good fit for a residential or a treatment program that's outpatient. In social detox, there's typically not medication involved, right?

That is really just a holding place for someone to go and to have a safe place for them to be. A lot of times, it's either jail or social detox. Medical detox is very much like you're coming in, and we are immediately starting to treat you for withdrawals; we know that you have withdrawals, and so we're going to start addressing those immediately when you hit the door.

Kevin P.: And so what would, I mean again, remembering our audience doesn't live in the world that you and I live in. What is Gallus, and when somebody calls and asks that question, what is Gallus?

Steve C.: Gallus is medical detox, and so all of our providers at Gallus are actually mostly trained in the emergency department. So when people come in, we're immediately putting in an IV, and we're pushing fluids and pushing medications to make people comfortable, right?

Because what we know is that if people are going through detox and they're really uncomfortable, their chances of staying are very low.

So if you come to a place like Gallus, we just get ahead of those withdrawals, and people stay comfortable, and then they typically make a better decision about going into treatment, and that's the ultimate goal. We want people to continue on.

Kevin P.: Cool, yes, awesome. So now, going down the path, I've brought my loved one to you, you've put the IV in, you've started to treat them proactively. Me as the family member, what should I expect?

What do you want from me? What kind of participation or engagement are we going to have? And as a family member, how do I support my loved one in detox?

Steve C.: Absolutely. So when your loved one hits detox, especially Gallus, there's usually a 24-hour period where we're just trying to stabilize and make people comfortable. And in that process, family can be as involved as the beloved one allows them, right?

So they will sign a release of information, typically myself or someone on my team a clinical director is calling them, giving them updates, sort of telling them what's happening.

And then the loved one will be invited to be a part of that next step process, right? To be a part of that identifying what programs are out there that are going to be a good fit for this person. And so, being a part of that process is really essential. 

Kevin P.: Yes, that was actually one of the follow-ups I was going to say is, so let's say that we haven't picked out a treatment center, but we know that the first thing we need to do is get them like you said physically detoxed, is that something you can help us with?

Steve C.: Yes, with identifying the program after? Yes. That is our primary goal and function, is trying to get that person into next steps.

I think the most important thing your viewers should understand, and you know this, Kevin, but the only predictor of success in recovery from substances is days in a recovery environment. So the more connected that person is, the higher chances of success, right?

Kevin P.: Yes, well, which I mean God, it's like you've read my questions; you're leading me perfectly into the next one. Which is what is the average stay in a detox facility? And again, as a family member, what should I expect on length of stay?

Steve C.: Yes. For alcohol at Gallus, we are pretty quick, so it's an average length to stay three days for people with alcohol use disorders, and a lot needs to get done in that three days to get them connected next step.

With opiates, you can expect people are going to stay seven or eight days, and that's a little bit longer of a process because of just the nature of those withdrawals and how opiates affect people.

Kevin P.: And was it I'm guessing that it's the same for benzodiazepines as well and prescription medications?

Steve C.: Benzodiazepines are really pretty tricky, and that can be up to 10 to 14 days, depending on how long and how severe that is.

Benzodiazepines can perhaps be the trickiest, and it's also important to know those are the most life-threatening, the most dangerous of all the substances that we deal with and detox.

Kevin P.: Which is, oh my gosh, I mean which is kind of a bonus follow-up question to that is the significance and why it's so critical to use a detox facility, as opposed to trying to do it yourself. So fill in the blanks there; why is it good to go to a detox center instead of like I'm just going to taper down myself?

Steve C.: For alcohol and benzodiazepines, those two substances, the withdrawals from them can be life-threatening. And what a lot of people don't know, with alcohol, the time frame where it's most dangerous is actually 36 to 72 hours after your last drink. People sort of expect if it's that first 24 hours, it's actually delayed where you're in that biggest danger zone of having seizures.

And with benzos, it's actually three to five days after your last dose, and so it's a really sort of delayed period, where those can be really dangerous. And that's why doing it at home is not a good idea.

Kevin P.: Yes, that situation I was telling you about last week, that was the argument that the alcoholic person was presenting well.

No, I can handle this myself, I just need, and the advice I was giving her loved one was yes, no, she needs to go to detox. And I'm sorry, I know you love her, but she doesn't get to make those decisions. She's not a Steve Carrollton expert, you know, did it again.

Steve C.: Yes. I mean, it's just a lot for people to wrap their head around, right? That stopping the substance can put my life in danger; that's very counterintuitive.

Because the goal of family is to get them to stop. And so understanding stopping too fast and stopping at home is putting yourself in a worse situation in some ways.

Kevin P.: Yes, absolutely. So hey, what trends have you seen during the pandemic? Because I know I've talked a lot to folks about the fact that everyone's been isolated, and things have definitely been exciting and interesting. But I'm curious on your end, what have you seen during the last year and a half?

Steve C.: Yes, it's really been interesting; things have started to shift a little bit in terms of a couple of things, alcohol, and opiates. With alcohol, people that were sort of teetering on that line, and that "functional alcoholic," right?

Where they would wait until five pm after work to start drinking. I think when you're at home, sort of I think that bottle calls to people earlier and earlier in the day. So we've just seen people go from sort of a relationship with alcohol that wasn't healthy, but they were still fulfilling some obligations.

To now, they're having a drink in the morning to stave off shakes. The other thing is fentanyl; I mean fentanyl that's the big one right now that we're losing a lot of people to, and I think the biggest thing there, and I don't know if this is COVID related or not.

But on the streets, dealers are pressing pills that look like a Xanax or look like an Oxy, and really, what's happening is they're taking fentanyl, and people do not realize it. A lot of people come in thinking, I'm taking Xanax, we do a drug test, and there's fentanyl, and they're very confused and scared.

Kevin P.: Which again is an even more another reason to be engaged in the professional detox environment, medical detox environment because you guys are going to pick that sort of stuff up and treat it appropriately.

Steve C.: Exactly, yes. If you don't know what you're detoxing from, then that's a problem, and that's happening a lot.

Kevin P.: Yes, wow, this has been awesome. I really appreciate all the information. Give me some last thoughts; what have we not talked about or tell me anything else?

Steve C.: I think what I see a lot in my work, Kevin, I know you do this all day every day, but it's just helping families with the fear, right? There's so much fear around this, and it's so hard to know what direction to go in, right?

I think the question I get most often from family is just what do I do, like tell me what to do here, right? And I think there are lots of different right answers, right? And I think helping people find the answer and the boundaries and the way they're going to navigate that, that feels right for them, that they do have options.

There are things that are within their control. Whether or not their loved one continues to use or not, not necessarily within their control, but your own behavior, the only the way that you're interacting and addressing it, you do have control over that.

And I think that's one thing that you get help for when you seek it, right? Sometimes the help is more for the family than it is for the person struggling with the addiction, and that's okay, and that's necessary.

Kevin P.: Yes, and like you and I both have done so much family work, and in-home family work that sometimes, that's how the whole process starts is actually getting the family to get on board and say hey, we're not going to do this anymore, we're going to take care of ourselves.

And if you choose to continue down your path of substance abuse, that's your choice, but we're going to start holding boundaries. I mean, I know for a fact that in 1990, my dad that's what he did with me.

He's like, look, so you're my only son, and I love you, but we're done, no more, and that's what started the whole process.

Steve C.: And it's such a hard thing to do. The other thing I think families should know is that even if somebody is sort of pushed or shoved into treatment, that can be effective, right? It doesn't matter sort of the agent for change or the reason somebody gets the treatment; it actually doesn't matter.

Statistically, whether somebody is forced into it or they choose it of their own volition, outcomes are identical.

I mean, then that's also important to know, so when they are having to set those boundaries and do those hard things, you're giving your family member a shot, right? Even though it can get ugly, you're giving them a chance, an opportunity, and that's the point.

Danny: Hey Kevin, we have a question from the audience on our Facebook live that I think you both could probably help with. So I'm going to put it on screen here for you guys. Can you read that, Kev?

Kevin P.: Sure. It says I think my, from Carrie, I think my loved one is going through this, and I'm not sure how to approach the conversation with them. Can you help guide me? So Steve, why don't you take a shot at it first, and then I'll jump in.

Steve C.: Absolutely. So just with the approach of the conversation is what I'm guessing she's asking there. And I think compassion; you lead with compassion. If somebody is starting to thinking about it like that is starting to change process.

And what you can do there is just approach them not with solutions, but more of like how can I help you, like I want to help you with this, I want to work together with you on this. Like if they're already thinking about it, that means there's already some type of traction there, and then you can get on the phone.

The recovery community is really a beautiful thing because even if you get on the phone with the wrong person, chances are they can point you in the right direction, right?

And so getting your loved one on the phone with somebody and doing that together like if they will let you do that, that's a great place to start, I think.

Kevin P.: Yes, I agree. I mean, if we have a family member that's like voluntarily saying, hey, I have a problem, and I need help, that's definitely a fantastic thing.

And even if it's something that Carrie may be saying is how do I bring it up to someone that I'm concerned about, I think that like it's the same thing. You can you treat it with empathy, love, and compassion, and I think you also toss in some boundaries as well and saying hey, I love you, and I care about you, and I'm worried about you.

And I think we need to get some help and be willing to engage in that slightly uncomfortable conversation.

Steve C.: Yes.

Kevin P.: Great.

Danny: And we had another question, Kev, that I can't put on screen, but it's on another channel. It's, is detox covered by insurance?

Steve C.: Great questions.

Kevin P.: Yes, go ahead, Steve.

Steve C.: So it depends on your insurance plan, right? And so I think the first thing you can do, and this is what a lot of people don't know, is they start by calling their insurance company. And then that can just go on forever.

And so one of the main things that Gallus and other rehab facilities can do, is you get on the phone, and that person, you give them your insurance information, they do what's called a verification of benefits.

And that admissions person will look at your insurance plan, they're going to be experts in what's covered and what's not, and they can call you back after doing that and tell you this is covered, this isn't covered, here's what you can expect. And so it's better to do that with a facility than with an insurance company, is what I'll tell you.

Kevin P.: 100% agree. And I happen to know the director of admissions at Gallus, Emily Schroeder, who is so awesome and so amazing, and she's just an incredible person and does an incredible job.

As well as I'll be in big trouble if I don't throw a shout out to my girl Laura Herman as well; who is your, what? Director of marketing, director of business development?

Steve C.: Yes, she's our chief of business development.

Kevin P.: Chief, oh my god, okay. Which tells, the thing I would say is that you guys have such great staff, and they do such a great job.

And you know what's interesting is that from a personal experience, is that we had a situation a year ago, where we worked with you for a loved one in our family that, and you guys did an amazing job and took great care of her.

And so we're very grateful. So I definitely have some personal experience with you. So all right, and well.

Danny: And Kev, sorry we have one more question, and it's not pulling up on screen, but I'm going to let you know what the question is. And you both can help this person live. This person essentially is saying that their loved one has been to detox multiple times.

They feel like it's been a way to get them to shut up or not worry about them anymore. They just go to detox, but then they don't follow through with treatment.

So their question is along the lines of what to do when your loved one's been to detox multiple times, and it doesn't seem like they're ready to change their life, and they're worried they're not going to take detox seriously the next time. 

Kevin P.: You go first, Steve.

Steve C.: Yes. This is sort of what we do at Gallus; a lot of people that come to us have had many bad experiences in detox, and unfortunately, there are some facts behind that, right? And so at Gallus, we are different because we're proactive in treating withdrawals, right?

And so when you can get, if you can get that loved one on the phone with somebody at Gallus, they can go through that process. The other thing that Gallus does really great with is we provide something called motivational interviewing every day while they're in our detox.

And because they're feeling better in that process, and they're feeling more hopeful and confident, maybe it can be different this time. Usually, you can get better traction and get them connected to aftercare.

And that's kind of where things typically fail and other detoxes, is they're miserable, they just can't wait to get out of there.

Kevin P.: And yes, exactly. And I would say that in the process, and I know you guys do this, in the process of bringing the loved one to detox as the initial step in the continuum of care, is working with the family and planning what the next step is going to be. Because I mean I have to tell you, I hear this all the time.

Oh, they went to treatment; I'm like, oh really, where'd they go? Oh, they went for five days to this place. I'm like, okay, that wasn't treatment, that was detox, which is great. But treatment is generally starts at a 30-day engagement.

So my families that I work with, what I let them know is that okay, detox is the great first step; I'm glad you've got them there.

But now it's our chance to prepare ourselves for that next step and holding the boundary of saying, okay, the next step for you is to go into this treatment program, and you're not coming home, that's not going to happen.

We love you, but we're going to hold the line like you said earlier, number of days engaged in recovery, that's what's critical.

Steve C.: Yes. And then I think when they're in Gallus, we can connect family with people like you, Kevin, and me and my clinical directors, we also can sort of help families set those boundaries as well.

And so it just opens up for more sort of avenues of help and support when they come to a place like Gallus. And one more plug there, I mean at Gallus, 85% of our patients that come through Gallus go into aftercare; they have some type of next step identified.

Kevin P.: And that's fantastic, that's wonderful, cool. All right, Danny, before I try to end, anything else?

Danny: We're good to go.

Kevin P.: Okay, all right. Well, it's great to have questions and great to have the engagement. And Steve, I'm so grateful for your time, and for the knowledge, and the information. And we'll look forward to talking to you soon.

Steve C.: Absolutely. Thanks so much for having me, Kevin.

Kevin P.: Okay. So thanks for tuning in again this week to the chronic hope podcast, the only podcast that is designed to help families that are struggling with addiction and codependency.

And if you get a chance, please go ahead and write us a review, like us on YouTube, Facebook, and Apple podcast and subscribe. And we'll look forward to catching up with you guys next month.

Outro: Thank you for listening to the chronic hope institute podcast with your host Kevin Peterson. Please, join us again next time. We exist to provide support, education, and hope for families who are struggling with addiction and codependency.

Remember to connect with us on Facebook, as well as subscribe to the chronic hope institute podcast on YouTube, Spotify, Apple, or wherever you listen to podcasts. See you again soon.

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