This summer, our 19-year old daughter had several seizures and when we begged her to give up her drug use she refused. (She abuses pot, opiates, ADHD medicine and alcohol.) In Florida, there is a law that allows concerned family/friends to have a person committed to involuntary treatment when they become a danger to themselves. We were able to enroll her into a partial hospital inpatient facility about 9 weeks ago. While there, she has refused to participate in group sessions and has refused all one-on-one help. She has been in and out of the psychiatric unit due to cutting herself and overdosing on prescribed drugs she has gotten or stolen from other patients at the center.
Now her treatment team is talking about a referral to a long-term treatment facility. I’m not sure if legally we can do this, but more importantly, will this be beneficial when she is so set against getting help? Do we let her drift away into a drug world she may not survive? What advice based on your experience and knowledge can you give us? We’re so sad and broken by all of this, but we’re determined to fight for our daughter’s future.
EXPERT ANSWER: This case is full of many layers of complexity. My impression is that she has unresolved traumas. She has tried to regulate them on her own due to her mistrust that others will not “get her,” and she is probably super sensitive to shame which gets in the way of wanting to be seen and creates a psychological and relational position of wanting to be “unseen.”
So, again just my impression is that she has used up her internal ability to regulate her affect dysregulation around her trauma or things that contribute to insecurity, and certainly she is not utilizing the resources around her. After the layers of drugs are peeled away, she will still have an affect dysregulation issue that she then tries to manage with cutting, maybe sex and controlling food, etc. or those might be the “yets” Underneath that is an inability to trust that others are a resource for her, and she will revert to going inward to harbor and manage the dysregulation and then run out of psychic energy and use drugs, cutting and acting out to sooth the internal tension and struggle.
This is a complex dual diagnosis case, and there are developmental issues where she is undeveloped internally. With all that said, I think it is important for the family to spend the money on a battery of good psychological testing vs. just an evaluation from a psychiatrist. From there, she and those that care about her will have a better understanding of the struggle, how she processes, where she is stuck developmentally and then everyone can have a more informed approach to helping her. From the case presented, this is how I would be thinking about her in my program and would be proceeding.
Jon Daily, LCSW, CADC II, Founder and Director of Recovery Happens Counseling Services
EXPERT ANSWER: I am hopeful that your daughter will stay in the long-treatment center until she can accept help. I I would like to suggest that you also get support from an addiction therapist who can help you get through your grief and give you some understanding of this disease. I would also strongly encourage Al-Anon. This is where you can talk about your pain without judgment and also learn from others how they are surviving a child’s chemical dependency.
If your daughter continues to pursue pain in her life, you are really helpless to change her. What you can change is yourself, and often those personal changes “prompt” a change in our loved ones. I remember that my own mentors always reminded me when I was going through hard times to “Go within.” That was the only place where I could find my peace. Just today I was reminded of this thought from The Secret: “Direct your thoughts and words to the inside of you. The Master within you is the key to all the treasures in the world.” I hope that idea is helpful to you while you are going through this difficult time of grief and fear.