How Many Shrinks Does It Take To Change A Light Bulb?

Just one, but the light bulb has to WANT to change.

Hello, and thank you for writing.  I am awfully sorry for the pain and distress you, your sister, and everyone who cares for her are experiencing as a result of her substance abuse.  Sadly, the abuse of prescription medications, particularly opiates, has only become more common over the past several years. 

Getting clean and sober is a mighty challenging task even for those who truly want to accomplish it.  For those who have not yet made a real decision to change, however, it's even harder.  As horrible as these "close calls" have been, they clearly have not motivated your sister to fully embrace treatment and recover.  They may, however, be moving her, gradually, toward "contemplation" of change.  This movement toward readiness does typically occur in individuals considering making a change, however subtly, but it takes as long as it takes.

In most states, involuntary hospitalization (generally lasting 72 hours) can be carried out when an individual's behavior has been life threatening (for the individual's or someone else's life).  This short amount of time is usually insufficient to make any sort of real dent in the underlying addiction, which is obviously a very powerful and habitual force.  Still, if the hospital you consulted is not assessing your sister's behavior to be life threatening, I would suggest calling another inpatient psychiatric unit.  Such an admission will probably anger her, and will certainly not "cure" the addiction, but it may disrupt her trajectory of addiction long enough to get her to reflect on her relationship to substances.  Such a step is taken given a full consideration of the "costs and benefits" of doing so.

As you may know, change often does not occur until we have "run out of options."  For the addict, this means "hitting bottom," and can involve legal, medical, professional, interpersonal or financial disaster and loss, or all of the above.  The creation of a "false bottom" can sometimes be achieved by a unified stance on the part of the addict's support system.  This is the method you have seen used, with some success, on shows like "Intervention."  The support system makes a collective decision to discontinue enabling the addict's behavior in every way if they choose not to seek treatment.  No more housing, no more money, no more contact, no more food, no more caretaking, no more anything. 

Obviously, this is an option of last resort, and the "system" must be very clear in their unanimous readiness to disengage from the addict if treatment is not sought.  If there is a split in the system, and the addict can continue to get their support from some members of the systems but not others, the chances of success are reduced significantly.  On the upside, however, rather than suffer "the death of a thousand cuts," the system can use this kind of intervention to really drive the seriousness of their stance on the problem home to the addict, and free itself from having to painfully and slowly walk their loved one to the grave.

Whether or not you elect to conduct an intervention with your sister, you may wish to seek the assistance of a therapist well-versed in issues of addiction, and it's impact on family members, for yourself.  You may also consider attending Al-Anon, NA or other twelve-step meetings to get such support, and to gain additional understanding of the best ways to cope with and manage such a difficult circumstance.

I hope you have found this information to be useful, and please feel free to write back if you have any additional questions, or wish to keep me updated.

I wish you great peace and courage in coping with this very challenging situation.

Sincerely,

Richard E. Schultz, Ph.D.