Expert: Peter L. - 9/20/2010

Question
Long story short; my son who is 26 lives with his mom and I. He started doing heavy drugs around 2 years ago and we have tried drug rehab numerous times and he always leaves too early and comes back home. He is tearing our family apart. The drugs have totally rewired his brain and he is delusional psychotic imo. He thinks that everyone is a drug dealer and is out to get him and he has alarms on all his windows in his room and keeps his door locked at all times. He goes to a drug rehab clinic everyday to get methadone and it makes him sleep all day along with doing other numerous drugs. He has a psychiatrist but he doesn't see how my son really is. Almost as if my son acts sane around the doctor and tricks him. We want him in a lockdown rehab facility where he cannot get out on his own accord. he needs serious drug rehab and mental help. How can we go about getting him into such a place is my question. He is not fit to think for himself. Please help; my wife and I are at our wits end.

Answer
Hi Brian,

These are heartbreaking situations and you have noted how difficult it is to find a solution.

First, I would recommend your son attend long term treatment.  Now that can be intensive outpatient, which would last several weeks and possibly longer.  He then should have some step down care like a relapse prevention group or individual counseling.  All of this could have him in treatment for a year or more, and all the research tells us the longer someone remains in treatment, the better the success rate.

Now another issue is that he would be getting this treatment locally, and no doubt has a network of people he knows and has used with or bought drugs from.  That may render the treatment ineffective.  In that case, he might be referred to a residential program in another part of the state or country.  Some of these are wilderness experiences, or just group treatment settings where the residents co-exist together, and there are self-help meetings regularly, chores to do, and safe social outlets.  Unless you can pay out of pocket, this option may not viable, as insurance will likely not cover.  But there are occasionally scholarships available.

Methadone is an effective therapy for opiate addiction, but it is localized, and puts him within access of other users.  

Your message suggests he's possibly rejecting of treatment (at least beyond methadone) so will not be willing to consider these options.

You are not obligated to keep him in your home unless he complies with your wishes.  I have seen a number of situations where family members demonstrate tolerance and patience (I'm not criticizing that, I understand) but I feel there has to be a limit.  It's my belief, but perhaps not of others, that not demonstrating what we regard as a tough love posture will only exascerbate the problem.   Sometimes asking a person to leave forces them to become engaged in treatment systems, if only due to a likelihood of legal problems occurring.  And no, it's not the role of law enforcement to motivate treatment, but consequences overall are the driving engine of change when it comes to addictive behaviors.  No consequences = no change.  He may not respond to any of your more tempered requests that he get treatment.  He may have to be forced to get it, and perhaps only what is available.  He will have to demonstrate a committment to remain until the treatment is completed.  He can't have it all ways.

I know of no lockdown rehab as you've mentioned; actually I do, and it's known as jail.  Not recommended overall, but sometimes I've found it can get someone moving who's really stuck.  

There are lockdown psychiatric hospitals, but one has to demonstrate psychotic behaviors or be perceived a threat to others.  Not an easy thing to convince someone of.

I hope this information is helpful, and maybe you (and his mother) can bring your son to an appointment with a drug/alcohol counselor to discuss his status. Make the appointment and tell him him he has to go.  

Regards,
Peter