Should you treat the addictions first?

[Think About It...]

My DD 25 battles a severe eating disorder and alcohol abuse.  Following the conventional wisdom we have been trying to treat those for the past 3 years with little success.  She does great as an inpatient in rehab when she has 24 hour supervision but when she transitions to the partial program she falls apart within a matter of days both drinking and binging and purging.  She has swallowed razor blades 3 times over the past 6 months always with the first time she drinks after being in a program.  I'm not even sure what to make of that but it scares me to no end.   The part of her that wants to get well works great when she's in rehab, to the point where the last place she was at let her stay for free when insurance refused to pay for any more treatment.  I think her illness (in the form of impulsiveness)  is keeping her from carrying over that healthiness on her own.

So my question is this; do you always treat the addictions first?  It makes sense that you would but it's definately not working in my daughter's case.  Even if we didn't I wouldn't know what else to do.
Does anyone have any experience with this?

Maribela

[Maribela]

My DD 25 battles a severe eating disorder and alcohol abuse.  Following the conventional wisdom we have been trying to treat those for the past 3 years with little success.  She does great as an inpatient in rehab when she has 24 hour supervision but when she transitions to the partial program she falls apart within a matter of days both drinking and binging and purging.  She has swallowed razor blades 3 times over the past 6 months always with the first time she drinks after being in a program.  I'm not even sure what to make of that but it scares me to no end.   The part of her that wants to get well works great when she's in rehab, to the point where the last place she was at let her stay for free when insurance refused to pay for any more treatment.  I think her illness (in the form of impulsiveness)  is keeping her from carrying over that healthiness on her own.

So my question is this; do you always treat the addictions first?  It makes sense that you would but it's definately not working in my daughter's case.  Even if we didn't I wouldn't know what else to do.
Does anyone have any experience with this?

Maribela

[Reality]

Good question and very controversial, to be sure.
Myself, I see the healing process as a dance.  Two steps one way, two steps back and swing to the  next partner...
Personally, I disagree with the concurrent disorder model, whereby the addictions are treated first.  With BPD, the emotional dysregulation is the underlying issue and if it is not treated, once the optimum environment, such as RTC, is taken out of the equation, the person returns to the repetitive self-harming, whatever iit might,  because the real issues have clearly not been addressed.  From that perspective, your daughter's cycling makes perfect sense.
The leaders of my Family Psycho-Educational Group for BPD have clearly stated that the substance issues gradually disappear as the pwBPD develops the necessary coping skills for dealing with distress and emotional dysregulation. 
Some thoughts.
Reality

[Vivgood]

Maribela, with such severe comorbidity issues, I would lean toward a dual-dx program with lots of structure. I think there is alot of self-medication going on (she is treating the baseline severe emotional dysregulation with EtOH and B/P), so failing to treat the BPD is a bandage when she needs sutures, KWIM?

I looked into dual-dx facilities for my BPDsister once, so I know they are out there...the issue is, can your DD get to a place where she WANTS the full tx, because at 25, your powers to persuade/influence are very, very limited.


vivgood

[Maribela]

How would I find such a place...look for places that specifically treat BPD?

[Vivgood]

The key phrase is "Dual Diagnosis". These are places that specifically deal with patients that have a mental health diagnosis and an addiction. You could start by Googling Dual Diagnosis in Kansas (or wherever you are). Vet places by calling and speaking to an intake counselor.


vivgood

[Maribela]

Thanks Vivgood.  Every substance abuse facility that she's been in has claimed to be dual diagnosis, but besides giving her access to meds, they don't address the mental illness piece.  I've been questioning our approach of treating the addictions first mainly because it hasn't worked I guess.  Honestly since the BPD treatment facilities are so expensive I couldn't afford it anyway.  And there's no guarantee that it would work any differently than treating just the self-abuse.  I just feel that her acting out is getting more and more dangerous and I ping pong back and forth between wanting to cut off from her completely (which I've been threatening to do for months) or rushing in to try to help her somehow.

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[Reality]

Maribela
That was our experience here in Canada with concurrent disorder programs/dual diagnosis programs.  The mental health issues were not addressed and there was no way in ... that my highly emotionally dysregulated son was going to stop self-medicating until he developed skills and strategies for managing the emotional pain and distress.  He has been in three different facilities and he just kept getting worse. 
Now that he is learning DBT Skills, he is slooooooooooooowly becoming healthier in many different ways, physically, emotionally, mentally, even spiritually.   I just keep practising Radical Self-Care and that said, I do it  rather poorly despite the lofty concept!  RSC rocks, though, when I push past my own crazy fear and emotional turmoil. 
This BPD whirl needs specific treatment, DBT, Schema Therapy or Mentalization Therapy.  It is a very difficult mess to unravel. 
Reality

[ontherox]

We are struggling with this same issue. Our dd19 has a drug problem and we keep bouncing around that issue without treating the BPD, and we_

[Neverknow]

We are struggling with this same issue. Our dd19 has a drug problem and we keep bouncing around that issue without treating the BPD, and we_

[heronbird]

Oh, its so depressing, I would never of thought Id be joining this club.

I seem to feel that although every person is different I think the route issues need to be addressed first, then if they are helped then they wont want to self medicate if that is what they are doing, which I believe they are.

Having said that, its not that easy and if they have an eating disorder, well how do you make that better or go away?

I would of thought if they were treated for BPD first, that would also help them to not do the reckless stuff like drugs and alchol taking to feel better, they should use the tools they learnt in their BPD therapy.

I really think everyone is different though and if the person has anorexia first then BPD, well that might be different. My dd has BPD first then bipolar although they are so similar. So confussing.

[More than sad]

Don't have experience with eating disorders  but getting sober made a big difference with my son.  AA
helped him a lot and allowed him then to get therapy help.

[mimimommy]

I agree that every case is different.  Reading biographies of women with BPD reveals to me that there can be change.  I do not think my daughter has the need to change; how can someone hit "bottom" when they view their entire life as the bottom?  In her view it is the world that is making her miserable.

I just ask her what she wants me to do and if it within my "safe ability"  I do it.  I try to end communication with," It"s your choice."
I stay out of her treatment unless she asks for help then I try to model and reinforce her brainstorming solutions.

My 28 yr old DD has been in and out of various treatment programs since she was 19.  With current BPD, BiPD, alcohol and drug addiction, no program seems to catch her interest. She has been in addiction, dual diagnosis and DBT . Voluntary and involuntary admissions make no difference.  She is also a thief.  Steals checks to get crack.  I am raising her 3 year old daughter,GD, so I have to have a relationship with DD.  DD is not ready to consider change and only goes into treatment as an escape from an acute situation.  Even the most expensive BPD dual diagnosis programs balk at her felony background.  We cannot send her out of state because she is out of jail on bond for a felony theft charge.  She will go to prison for 6 months and then when she gets out we will try to put her in a program, if she is allowed to leave the state.  Six years ago when she left prison she went right back to drinking and using crack while in a DBT group.

mimimommy

[peaceplease]

Addictions need to be treated first.  Then while in dual diagnosis treatment, both are addressed.  Mental illness is usually at the root of drug addiction.  

Another thing about addiction, it is said that at what age their drug problem starts is the age of maturity they will be stuck in, until they get sober.  When I complained of my dd being stuck in her teens, my T told me that she was stuck at the age of her inital addiction. Make sense?  She was 15 when she started.  She has improved in so many ways, but I still see that risk-taking behavior.  Teens feel that theya re invinceable.  I believe that my dd is still stuck in that stage.  Her drivers license is suspended due to a dui, but she continues to drive.  It is not just here and there.  She has not curtailed her driving at all.  She has had the scares of police following her.  She has so much to lose, if she gets caught.  However, she continues to take chances.  And, all I can say is, Radical Acceptance at this point.  I gave up warning her.  She just replies that I am jinxing her, and she does not want to hear it.  

My dd has been weaning from methadone treatment for opiate addiction.  She hopes to be done in 8 weeks.  Originally, she started to wean because the judge told her that she cannot get her license back until she is methadone free.  She would be getting her license back when methadone treatment is completed.  But, she was disqualified from the accelrated rehab program due to three dirty thc tests.  So, now she has until February that she can get her license back.  

She never really got the drug problem resolved.  She is no longer buying pills or snorting pills. However, she can't give up pot.   Her case manager has told her that she needs to have outpatient therapy for her mental illness.  As, if her depression and anxiety were resolved then she would no longer need to smoke pot.    So, really both problems need addressed, but i think the drug problem needs to be treated, initally.  Then, can look at reasons why relapse always happen. 

[Neverknow]

**********
Whoops!

[cfh]

Great question but with no easy answer.  MY ds (28) was born with all sorts of issues and by 13 pdocs started to put names on them.  The drug abuse started at 18 as soon as he walked out of an RTC.  I don't believe there's a drug he hasn't tried and he was a heroin addict for 8 years...currently on suboxone along with many other meds. 
He considers himself clean and sober because he is "only" on prescription meds.  Yet he self medicates with those meds by taking them on his own schedule. 
I don't think he can get through the day without knowing he has that crutch yet I think he could get through the day better if he had more coping skills...yet how can he learn those coping skills when he pops a few xanax to get through those rough times?  So it goes round and round.

[Reality]

You know, I used to think that harm reduction was for the birds; however, I am now a convert.  It sanctifies a slow weaning off substances, legal or illegal.  They are all the same to me, frankly and in a way, the pharmaceuticals scare me even more, as it is so easy to overdose or to mix dangerously.
Just my idea.
Reality

[mimimommy]

I agree there is no good answer. 

As they say in DBT, the patient doesn't fail the treatment the treatment fails the patient.  And just as we may not have been, and continue not to be, the parent that our diagnosed child needs, we can try to find a healthy way to support them in their lives. 

I have decided that it is not my role to find the perfect treatment facility.  But I am dealing with a 28 year old.  And I have only recently come to this conclusion.

We searched for twenty years for therapists and doctors and programs.  This is the norm for mental illness and personality disorder.  I have worked with NAMI (National Alliance on Mental Illness)  as a teacher and support group leader for over six years and have been in Al Anon for  nine years.  I have learned that we have to take care of ourselves first and then learn to create a healthy relationship with our diagnosed child.  I am finding this challenging enough without worrying about finding the best treatment.  I view my role as that of "Encourager", supporting my child in using her logical brain to find resources.  Although no program has helped, she has been more "invested"  in programs she has found.
mimimommy

[jdad]

I too have heard that "dual diagnosis" and treatment is the best strategy. My wife and I spoke at length with the director at an inpatient facility that specializes in such care. It starts with 30 days in-house, followed by at least 60 days of outpatient treatment.

Does it work? I don't know. We can't get our daughter to go into any kind of treatment. Any time we raise the issue, she gets indignant and treats our suggestion as an invalidation. What follows is days of vituperation and hostility.

I hope you and yours have better results.