Further Reading

My daughter is out of drug treatment; is she depressed and should I send her to a psychiatrist?

Dear Dr. Peele:

My l7 year old daughter has just returned from four weeks in a drug and alcohol treatment facility. She is considered a "garbage head" since she does not have a drug of choice, although I have heard heroin mentioned several times. In one of her "open statements" she mentioned she started using drugs to fill the hole inside her. My question is whether she has a mental health problem or an addiction problem. Now that she is out and currently in recovery (and wants to do things HER way), do I find an addictions counselor or should she be seeing a psychiatrist for perhaps depression and/or bipolar disorder or some other kind of mental and/or chemical imbalance? Did the depression come before the addiction or the addiction cause the depression? Her attitude is very passive. She has never been abusive in any way.

Please point me in the right direction. I have been told to deal with the addiction. However, if she has a chemical imbalance due to a mental illness, shouldn't we deal with that so that she can have a clear head in order to deal with her recovery process? As you can tell, we are new at this, although she is the youngest of five children.

Thank you.
Kathy


Dear Kathy:

Children who go through treatment have been presented a model of chemical dependence. It says they are inherently addicted, and should avoid all contact with drugs and alcohol. This is a tall order for most kids. Among other problems (aside from the fact that you can't tell whether a kid is permanently addicted) is that most are set up for failure — if (more likely when) they consume a psychoactive substance, they quickly descend back into their old lifestyle and drug habits. An addictions counselor will continue this perspective.

The way to think of successful change is that you daughter will be developing a new lifestyle. To remain clean (meaning no longer focussed on drugs and alcohol), your daughter will have to spend time differently, with different people, and think about herself differently. What will that take? You and she have more of the answers than do I. But it takes some planning, thought, and effort — something treatment centers are usually completely negligent in assisting with. Some of the typical questions to focus on are: Who are her friends? What does she enjoy doing in her spare time? How does she approach school?

You and your daughter both realize there is more to her problem than this. You're on the right track. Your daughter's statement about the "hole inside her" is important and worrisome.

I can't diagnose your child. You seem to want to place another diagnosis on her in place of her chemically dependent one — bipolar, depressed, etc. There are record numbers of young people who are diagnosed this way, and remarkably large numbers of them are prescribed antidepressants and other drug therapies. Psychiatry has become completely wedded to such treatments, and so will you and your daughter if you go to a psychiatrist. Note that she will still be dependent on drugs, that this dependency may become permanent, and she will still be passive and not in control of her mental health.

Perhaps you can speak to some parents about their experiences with the chemical dependence and psychiatric systems, to see what they have learned. I would also seek a counselor who can help your daughter sort through her feelings, rather than immediately prescribing drugs for her. I would try to talk to her and assist her to find alternate ways of spending her time and gaining satisfaction. I would gently enquire about who she is friendly with. I would see how she is thinking about and progressing in school, and get her academic assistance if that is called for. I would try to get her engaged in some positive activity that she really likes and that can help engage her being.

You have a number of assets for doing this. You are intelligent yourself. You have four older children who you have assisted through their teen years. You have a husband. You have other relatives. What about your other children? What are their opinions? How about a family meeting?

I sometime speak to people who have had a terrible crime committed against their children. If they can take it, I tell them that the crime will never be solved unless they become the prime movers behind the police investigation. The same is true with the mental health system.

All best,
Stanton