Expert: Peter L. - 2/22/2011

Question
I recently found out my 19 year old son has been smoking roxie and/or crack for several months.  He has not lived in our home in over a year because he did not want to follow simple rules.  He has smoked marijuana since 14 on an almost daily basis. He has "experimented" with numerous drugs - excatasy, cocaine, acid, zanex.  He has been in several out-patent programs and has had numerous therapists.  He was also Baker Acted two times. Nothing seems to phase him.  He is a master manipulator and manages to talk his way out of trouble. I thought when his friends Baker Acted him it would have some effect, but he was just angry at them.  The therapists told me he would not cooperate, did not want any help and there was nothing else we could do.  That was a year ago.  He was now evicted from his 3 apartment and has no car, job or money but somehow still has drugs.  We live out of state due to a recent job transfer.  We went and got him to live with us away from his influences in a new environment.  I am afraid of withdrawal symptoms and how to handle them.  Also we would like to get him to rehab, but was told if he force him it will have no affect and we need to "guide" him to come to that decision himself.  How do we accomplish that and what is best?

Answer
Hi Jackie,

I apologize for the delay in answering you.  The situation you describe with your son is obviously one with no simple or reliable solution.  The key here is that most adolescents with substance abuse problems have co-occurring mental health disorders, and will usually not stop using addictive drugs without the mental health symptoms being treated.  The fact that he's been involuntarily admitted for treatment suggests significant mental health difficulties.  

There is some correctness in the statement that forcing him to rehab will be unproductive.  Generally, with teens, one strives for less treatment than more.  The idea is to work with their inherent resistance to treatment overall.  Teens do not experience the same consequences as adults stemming from their addictive drug use, so are not as "connected" to consequences.  It's harder to sell abstinence and recovery to them.  They're young, resilient, and feel in control of what they're doing.

Now one exception to the less-is-more strategy is to have a young person go to an outdoor-based retreat.   The idea here is to get this individual away from peer environments, get them outdoors in settings where they have to fend for themselves, and where they can't just one day say "I don't want to do this."  It's easy for them to reject typical community based treatment -- simply stop attending. That's not the case in the wilderness.

So, yes, guiding him to treatment is the wise approach.  Again, with the less-is-more strategy, you might try to identify a local substance abuse counselor experienced with adolescents, who can sit with your son and just talk about things in general.  This counselor will initially avoid conversation about substances, and focus on friends, family, mental health, self-concept, self-esteem, etc. avoiding substances at first.  If a relationship develops, it's much easier to "sell" higher levels of treatment as it may become necessary.

He will not have any withdrawal symptoms that are health-threatening stemming from ecstasy or cocaine.  Zanax, and the benzodiazepine family can be more of a concern in that regard.  If you see him having physical difficulty you'll definitely want to have him medically evaluated.  It all depends on how much he's using and how often.

I would be active in your pursuit of a solution with him, that is, don't just give up and resign yourselves to his having intractable addiction.  As a young person, he needs to have concerned people help steer him toward a path of wellness, wherever that comes from.  Teens have faulty judgment regarding substances, and should not be allowed to do what they are doing without consequences, even if those are not particularly extreme as with adults.  If he's under your roof, there should be expectations.

This is not easy, but I've seen young people respond to caregivers concerns and interventions eventually.  Those who stay with it are the most likely to gain the better results.

I wish you the best with your son.

Peter