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May 25,2007
Lifewire: 'Constructive Coercion' and helping the addict you love
by Ven Griva

Substance abuse and addiction are problems so widespread in the United States that they are difficult to put in perspective.

The Substance Abuse and Mental Health Services Administration, an arm of the U.S. Department of Health and Human Services, estimates that nearly 1.5 million emergency room visits related to illicit drugs, alcohol and non-medical use of pharmaceuticals were made to U.S hospital emergency rooms in 2005. That's the most recent year for which there are complete statistics.

What's more, that number fails to take into account the total number of alcohol-related ER visits because the administration does not collect data for such visits by individuals over the age of 21.

It is safe to say that at some time in their lives, most Americans will find themselves concerned about a friend or family member they suspect might be abusing drugs or alcohol, says Dr. Laurence M. Westreich.

Westreich is a board-certified psychiatrist who specializes in the treatment of patients dually diagnosed with addiction and mental disorders. He is a professor of clinical psychiatry in the Division of Alcoholism and Drug Abuse, Department of Psychiatry, New York University School of Medicine, and serves as the consultant on drugs of abuse to Major League Baseball.

In his recent book, "Helping the Addict You Love: The New Effective Program for Getting the Addict into Treatment" (Simon & Schuster, $25), Westreich says that in society there are conventional wisdoms about drug addicts and alcoholics and whether it is even possible to help them.

One such conventional wisdom is, to let them "hit bottom."

"The trouble with that," Westreich said, "is that the 'bottom' can be death. You want to be able to look back and say you did your best."

The other conventional wisdom is that you can't force a drug addict or alcoholic to make beneficial changes in his or her life, "no matter how much of an effort you make to convince, cajole or command" unless the addict is ready.

After years of practice, Westreich has come to believe that the first piece of conventional wisdom is too dangerous, and that the second is not true.

"I've seen families unite to convince an alcoholic parent - a woman who had been in denial for years - to address her alcoholism," he writes. "I've seen groups of friends band together to help a member of the group stop dangerous cocaine or heroin use. Pulling together family and friends can act as powerful change agents in an addict's life."

What he advocates in "Helping the Addict You Love" is letting the addict or alcoholic know that you are concerned for their well-being. He calls it "Constructive Coercion" and differentiates it from intervention in that there is no surprise and no ultimatum.

"I think it is better - from both the emotional and practical standpoints - to frame the interaction with the addict as an attempt to help rather than as an attack," Westreich writes. "Constructive Coercion accordingly focuses on the friends and family's concern for the addict rather than on whatever threats they may make."

In that light, the book lays our strategies for persuading a friend or loved one to get counseling and treatment. It also does a good job of defining addiction counseling in general, and the specific types of mental health professionals who work with addicts, such as psychiatrists, psychologists and addiction counselors.

It also explains what treatment is, what to look for in a treatment facility, detoxification and medications, and the benefits and drawbacks of Alcoholics Anonymous and other peer-led groups.

There is information on how addiction is a mental illness and how addicts' brains are wired differently than those of people who can use substances and avoid addiction.

Westreich says that contrary to conventional wisdom, it is possible for the family and friends of drug addicts and alcoholics to steer their loved ones toward beneficial treatment.

"I see addicts get great results from counseling," he says.

Here are some questions from "Helping the Addict You Love" you can ask yourself in determining whether a friend or loved one in your life has an addiction problem:


- Has the individual become so tolerant of the effects of the substance that he or she has to take more to achieve the same effect?

- Does the individual exhibit symptoms of withdrawal?

- Does the individual continue using despite negative physical effects such as skin infections and weight loss?

- Has the individual ever harmed himself or anyone else as a result of substance use?


- Does the individual take more of the substance than he or she intends?

- Does the individual continue taking the substance despite negative emotional effects?

- Does the individual use the substance to feel better?

- Does the individual forget what happens when he or she uses the substance?


- Has the individual's marriage or other relationships been affected by the substance use?

- Does the individual's substance use worry other members of the family?

- Does the individual get into verbal or physical fights while using the substance?

- Does the individual, while using the substance, have sex with people he or she otherwise would not?


- Has the individual's work productivity or attendance suffered as a result of substance use?

- Have the individual's grades or attendance suffered as a result of substance use?

- Does the individual use drugs while on the job or at school?


- Has the individual been arrested for anything related to drugs or alcohol?

- Has the individual been stopped by the police for any reason related to drugs or alcohol?

- Has the individual committed any illegal act as a result of his or her substance use?

If the answer to any of these questions is yes, Westreich says there is reason for concern. It would be better to ask about the issue than to remain silent, he says.

E-mail Ven Griva at ven.griva@copleynews.com or write to P.O. Box 120190, San Diego, CA 92112.  © Copley News Service

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