Dear Dr. Bob,
My son is 38 years old and lives with his girlfriend in a mother-in-law cottage behind our house. He sits around and smokes pot all day for the last 20 years and doesn't work. She works to pay the bills, but the rent is free from my husband and me. What do I do?
Dorothy, Castro Valley
Dear Dorothy,
Your son seems very charming in that he can get his girlfriend to pay the bills and his mom to pay the rent! Any answer to your question depends on gathering a little information first. Does your son provide some sort of service, physical or mental, for you and your husband? For instance, does he take care of the property for you? Does he take you and your husband to appointments or act as a companion for either of you? Are you and your husband in agreement that something needs to change? Do you want him to stop smoking pot, to move, or both?
Any action by you and your husband toward your son's drug use or living situation will be ineffective if the two of you are not in agreement. If your son provides some sort of valuable service to either of you, that person may not want to "rock the boat" and accepts the situation just as it is.
Adult children living at home can pose some interesting legal difficulties. On the one hand, he is no longer a legal minor and you are no longer legally responsible to provide a home for him. On the other hand, if he has been living there for very long and it is considered his legal residence, you may have to evict him. Please consult an attorney.
It used to be common wisdom that you couldn't help an alcoholic or addict until they "hit bottom". Formal and informal interventions have proven effective in "raising the bottom" to motivate change. This is where the family confronts the alcoholic/addict with accounts of problematic behavior. The family shares their heart felt concerns about the alcoholic/addict's future, should these behaviors continue. They plead, request and or demand the alcoholic/addict seek help to change. The family has some form of leverage (like evicting him from the mother -in-law cottage) that can be used to help motivate the alcoholic/addict to make some changes, even if he doesn't want to. If still unmotivated, the family must be able to enforce that leverage. Otherwise your demands are really just hollow threats. Often the family needs help with setting limits, following through, and understanding enabling before confronting an individual with addictive disease. Al-Anon, CODA, and/or therapy are good places to start. As the saying goes, "when the family gets healthy, the alcoholic/addict gets healthy." Good luck!
Dear Dr. Bob,
I recently attended a lecture on alcohol treatment, and for the first time I heard of something called "harm reduction theory". This is way different than anything I've heard of. How can drinking not be a relapse?
Alfredo, Watsonville
Dear Alfredo,
To understand "harm reduction theory", it helps to understand the "disease model' of alcoholism. The American Medical Association pioneered the concept of alcoholism being a disease, because it fit the profile of other diseases: identifiable symptoms that were chronic, progressive, and treatable. Left untreated, this disease was fatal. Once someone develops this disease, like heart disease and diabetes, it can not be cured. But symptoms can be managed or controlled. For heart disease and diabetes, they are controlled through diet, exercise and medication. Alcoholism is managed through abstinence. Although there are several medications available that will adversely affect alcohol in the stomach or decrease cravings in the brain, these are not usually considered life long solutions. Abstinence is where the medical disease model and Alcoholics Anonymous overlap.
There are harm reduction theories used in this country, the "designated driver program" being one of the more popularly know. It does not advocate abstinence, it just works toward reducing harm. But harm reduction treatment of alcoholism and addiction is not as common in the United States as it is in the rest of the world, including Canada. It theorizes some alcoholics and addicts can not be "helped" through abstinence. Therefore, allowing them to use alcohol or drugs in a managed setting to reduce the harm to themselves and society is advocated. The financial costs to society are extremely high for the almost daily arrests, jailing and hospital emergency room admissions for chronic late stage chemically dependent individuals. In a controlled harm reduction setting, medical, nutritional and psychological issues are all addressed, something that would not happen on the streets. The financial costs to society are considerably less. Individuals also get sober, although that is not the goal. Letting alcoholics drink is controversial, to say the least.
In many communities where "hard" drug addiction is rampant, particularly opiate and crack cocaine addiction, the damage to individuals, families and communities is staggering. Harm reduction theory does not advocate for abstinence of all substances as the goal. The goal is getting off the heavy drugs and relapse would be using opiates or cocaine again. But alcohol and marijuana use would not be considered a slip. In essence, the goal is to accept "soft" drug use and reduce the harm to an individual and society of the medical, psychological, legal, and violent issues associated with "hard" drug use.
Each theory, the disease model and harm reduction, has its success with certain individuals, certain communities, and certain chemicals of use. And there are other theories of how to treat addiction besides these two also. It takes an open mind to look at all addiction treatment approaches and their underlying theories of causation, reason for their interventions, and their definitions of success.
Dr. Bob
Dear Dr. Bob,
I was at a meeting where I heard an old timer talking about getting a "hummer" on the way to treatment. Is that what I think it is?
Dani, Orinda
Dear Dani,
I'm not sure what you're thinking or the "old timer" meant by a "hummer", but I've heard the term before and I'm not referring to the ice cream drink. It has to do with the detox experience. Alcohol enhances or increases the amount of the neurotransmitter, GABA (gama-Aminobutryic acid) in the brain. GABA is the main inhibitory neurotransmitter that regulates or depresses excitability. When a chronic drinker removes alcohol from the body and brain, there is less GABA, or less enhanced GABA. The brain becomes unregulated, hyper excited, resulting in muscle spasms (DTs), hallucinations, seizures, and other alcohol withdrawal symptoms. Depending on the severity of the symptoms, hospitals often times treat alcohol withdrawal with quick acting tranquilizers or other GABAergic medications, which increases GABA, and has a calming effect on withdrawal symptoms. Years ago, when residential treatment programs were not associated with physicians or medical programs, alcohol was given to clients to increase GABA, which decreased the withdrawal experience and prevented seizures. How a few drinks on the way to a program got the name "hummer', I don't know.
Dr. Bob
Dear Dr. Bob,
I am searching for a therapist and I see people who have a Ph.D. and a Psy.D. What's the difference and which one makes a better therapist?
Julie, Mill Valley
Dear Julie,
There are some significant differences between the two degrees, which may have little to do with who is a better therapist. The abbreviation Ph.D. comes from the latin word "Philosophiae Doctor" or Doctor of Philosophy. Although some universities around the world still use the abbreviation Dr. Phil., it morphed into Philosophy Doctorate (or Ph.D.) in this country in the mid 1800s. The Ph.D. is granted to someone who has done original research and can be awarded in almost any field. The outcome of the research is producing a dissertation of significant depth and breadth (like a book) that expands knowledge in that field.
If the Doctorate is not in Philosophy, it is still called a Ph.D. with a focus or concentration in the field it is being awarded. A Ph.D. in psychology is a Doctorate of Philosophy with a concentration in psychology and a focus on research.
The Psy.D. is a doctorate of Psychology with a focus on clinical work. It was originated 20 years ago or more, because most psychologists do clinical work and not research. The focus of a Psy.D. degree is to become a better therapist through an educational curriculum that focuses on psychotherapy. Those obtaining a Psy. D. have to meet the same number of educational requirements as a Ph.D., including a thesis.
All therapists need to have a license to practice privately. They could be a licensed clinical psychologist, licensed marriage and family therapist or a licensed clinical social worker. The later two licenses need to have a Master's Degree and licensed clinical psychologist needs to have either a Ph.D. or a Psy.D. Having clarified the difference between the two doctoral degess, the important issue in therapy is the "fit". Most research, in spite of theory used, says the relationship between the client and the therapist determines the best progress and outcome.. Therefore a good therapist may have a master's degree and a MFT or LCSW license, for instance, and be a better fit than a therapist with more education or a clinical psycholgist license.
The best way to find a therapist is to talk with a friend or family member who has had a good experience, regardless of which degree or license. See if the therapist specializes or is very familiar with you issues. Try to get a "sense" over the phone as to whether you feel comfortable. Some therapists will give a free consultation to see if the "fit" works both ways. Good luck in your search!
Dr. Bob
