Sunday, July 24, 2011

Addiction and Adoption

Adopting an addicted child, which is certainly not what I set out to do, and ended up doing anyway, is complicated. As T nears the end of his second successful month in residential treatment, I've had a lot of opportunity to reflect.

I grew up in a family where we spoke openly about addiction and recovery, because my mother had four brothers, three of whom went to treatment during my grade school years. The vocabulary of recovery and self-understanding is familiar to me, and I grew up in a context of understanding that addiction is a disease and recovery is a lifelong project that requires restructuring every area of one’s life.

However, when I became the parent of a substance abuser, I felt unmoored. A lot of writing about addiction and families focuses either on partner dynamics or on family pathologies that gives rise to addiction. I wasn’t really able to find one single thing written about adoption and substance abuse as we navigated our path with T. The commonly available sources seemed to fall into one of a few categories: the tough-love approach (a potential disaster with seriously traumatized children in my personal opinion); the literature about enabling and boundaries (mostly written on the assumption that the addict is an adult), and the common writing for biological parents of teens who are “at risk”, focusing on prevention (far too late for us for that).

What’s unique about a situation like ours is this:

T was way beyond “at risk.” He was “at risk” the moment he was born into chaos and suffering, addicted at birth. By the time I met him, he’d been using drugs every morning since the age of twelve, he was frank about it, and he could tell you with the presence of a 40-year old how drugs seemed to help him tolerate the abuse and alienation he suffered over the course of 14 years in 16 foster homes. He wasn’t making an excuse – he held his addiction up as a raw fact. He knew he needed to do something about it, but he was quite frank that he had no idea where to start. The writing on early intervention with teenagers—which tends to operate from the point of view that you’ve just found out your kid is in the early stages of drug use—made me feel like we were standing around talking about buying fire insurance when the house was already burning.

Second, the writing I found about family dynamics and addiction didn’t account for older child adoption, of course. In other words, the writing for families of addicts assumed that the people involved had always been a family. But T doesn’t have a cohesive family of origin – he has an assortment of birth relatives whose connections are broken up by extreme poverty, substance abuse, violence and constant relocation, as well as dozens of former foster parents and other assorted people who have parented him at times. Helping him means grappling with an exponential equation of complicated family dynamics involving people we don’t even know. Recovery means making sense of all of that history and figuring out which relationships need repair.

Finally, there just isn’t that much written about parenting the addict. T is a child, chronologically 17 and developmentally much younger in some areas of his emotional life. Some of the writing about addiction focuses (appropriately, of course) on boundaries and limits. As a new adoptive mom, I felt trapped in a huge dilemma; perhaps the only situation I can think of where one is truly obligated to stand by another human being unconditionally, regardless of the cost to oneself, is that involving a parent and a young child. And T sometimes is, emotionally speaking, a very young child. I felt keenly that if I erred too much on the side of setting limits with him, I would risk triggering the shame and alienation that underly his misbehavior and threaten the bond we were building. But of course enabling substance abuse was also obviously unacceptable. If there was a book written for parents of drug-addicted three-year-olds, that’s the one I needed. I really found nothing in the substance abuse literature that reflected our experience as adoptive parents of an already-addicted child. One thing we knew throughout is that we could not withdraw our support nor deliver an ultimatum that would sound like we were going to “give him back” – his ever-present fear and expectation.

I’m happy to say that today he’s been sober for two months! Longer than he’s gone without drugs at any time in the past five years. Not only am I happy and proud beyond words, but T is very proud of himself. He wrote me a letter recently, in which he exclaimed “I feel the happiest I’ve ever felt!” He is working his program, waking up every day and trying his damnedest to learn how to live an honest life without the anesthesia of addiction. He's working with his treatment team to get the right medication for ADHD (a diagnosis I mistakenly resisted for a long time, and now understand is key to his recovery).

Sober, T is an unusually perceptive, soft, receptive human being. Sober, his heart is finally convinced that he is loved and connected. He's begun reading, voraciously, again, and writing poetry and long, expressive letters in his funny, formal prose. He has worked his way up in the hierarchy at the treatment house and he takes as much pride in that as another kid might take in making first string on the varsity football team.

Best of all, quite unexpectedly, getting him in residential treatment made a huge impression on him in terms of what it means to have parents. When he was in his darkest depths last spring, I told him firmly "A loving parent doesn't let this happen. A loving parent steps in when your judgement is broken until you're ready to take over again." He trusted us enough to cooperate. Now, he finally has an example of what that kind of love means. It shows on his face.

I liked this quote in the book In the Realm of Hungry Ghosts, which one of the readers of this blog recommended to me and is now one of my most treasured reads. “Misplaced attachment to what cannot satiate the soul is not an error exclusive to addicts, but is the common condition of mankind. Our designated “addicts” march at the head of a long procession from which few of us ever step away.” I've learned a lot by working with him through his struggles. It's been soul-satisfying for all three of us in a most unexpected way.

Thursday, July 14, 2011

Here We Go Again

We had a visit last night at the treatment house, and a chance to meet T's therapist. The visit started out with a little "talk" that began "T is having some problems..." We heard about a food fight in the dining room, some talking out of turn in class, and some belligerence toward another kids. Then she said what we've heard so often from school administrators - she told him that he's on the verge of getting kicked out.

After that, she asked us to fill in some gaps in his history. Thanks to his social worker, who had to manage his intake at the treatment house for legal reasons, they have no history on him. All they know is that we've been trying to adopt him. So she asked me about his early childhood. As T and I walked her through it, she struggled to absorb the story. She kept asking about his birth mom. Finally, T said to her "I went into foster care at birth." She looked shocked. She asked if he was born drug addicted, and seemed surprised when we said yes. She asked the usual questions about childhood abuse, and the answer to every question was yes. I offered to draw her a timeline. I showed her how many placements he had, and the abuse that happened at various points along the timeline. I asked T's permission to speak freely about his history, which he granted, because he has always been frank and open about it. As the therapist listened, she teared up and could hardly talk. She told him how sorry she was with tears in her eyes. She saw what one always sees when one looks at the trajectory of T's early childhood: this is not supposed to happen.

This is the third or fourth time we've tried to get up to speed with a new therapist, only to find that they shy away from his history or have trouble absorbing the full force of its chaos and tragedy. This therapist has already diagnosed him and prescribed medicine on the basis of a few initial meetings. And yet she didn't know anything about his upbringing. She began the session by lecturing him about how he needed to try harder in the classroom, and yet she didn't know enough about his early childhood to understand why impulse control might be so challenging for him, or why it might be the case that he learned early on that negative attention is better than nothing. She let him know that he might be kicked out of the residential program, without understanding what that feels like to a kid who's lived in sixteen homes in his young life.

All this said, I like the treatment house and so does T. He is really doing the hard work there now, trying to learn to manage his behavior in the clear light of sobriety. He has good people on his side, and most important, he has other kids whom he supports and who support him in a true community. For as long as it lasts, it's a great gift and he knows it and he's making the most of it. He is open and aware in a way he's never been before.

But a part of me has sort of given up on therapy. I don't know why it is so hard to find a therapist who can be as frank and as open as he is about his abuse history. Until we do, he has other supports and he has formidable internal resources and he may just get what he needs through methods other than therapy. I used to put a lot of faith in therapy, but I don't anymore. Behavioral coaching, support groups, strong friendships, and connection to us have an obvious healing power. Therapy, so far, not so much. I am sure there are very able, knowledgeable therapists out there, but in my experience they're exceedingly hard to find and few programs are equipped for a child of his age and background. I've come to look at therapy as one method among many for healing, and, in the absence of a highly skilled and experienced practitioner, often not the best or most accessible.

Friday, July 8, 2011

Happy Endings

The other day one of T’s relatives wrote to me and said “It’s so great he went to treatment. The hard part is behind him now.” Uh, not at all! I thought. The hard part is coming back to all of us and maintaining his self-determination! The hard part is continuing to live truthfully, hanging on to the wisdom that’s inside him in the midst of other people's denial.

I had the chance to experience a little bit of the pressure of other people's denial this spring when I was starting treatment for thyroid cancer. When I had surgery to remove my cancerous thyroid, people kept saying “It’s great that it’s all over now,” and “I’m so glad it’s taken care of.” Even when I explained that surgery was only a first step, and it might be several months or even years of ongoing treatment before I could finally be declared cancer-free and manage the side effects of treatment, it didn’t matter. They wanted to think that the hard part was past, and so they did. I suppose ambiguity and mortality make us uncomfortable. As a result, after the initial drama of surgery, I felt somewhat alone. I didn’t want pity or angst - I've adjusted to living with the disease and its treatment. I just wanted to be able to tell the truth about it.

I see a similar thing in T’s situation. The people in his life who believe the hard part is behind him now are well-meaning, but they are not well placed to be helpful. This is only the first step for him. It may not even be the hardest step. He may face his darkest hour sometime later. He has acknowledged--even wholeheartedly embraced, at the moment—that addiction is a problem for him. But living through life's inevitable difficulties and losses without the anesthetic he learned to rely on so early in his life is going to be really hard. He has a terrible time managing stress. He is not able to sooth himself effectively, no doubt because he was not soothed in his early development. Ordinary daily conflicts and problems hit him with an unfiltered force and confusion. There's no easy fix for that - it's a life project. It's not fair that he has to work so hard, but he does, and he needs friends and family to back him up and stand by him.

His treatment program is a wonderful respite for the moment. I feel like they are a strong eggshell protecting the soft yolk of his newly sober self. For the first few weeks, he was so proud of himself for being able to abstain from drugs that he felt like it was going to be a cakewalk. Then it got hard - he got into some conflicts with other kids, he lost his temper with an administrator, he refused to cooperate with some of the coursework. He demanded to come home, and raged at them, displaying the common stress-driven behavior that plagues him at school. But of course, they know what to do. They sat with him, calmed him, reminded him that he's there to work on this behavior and if he doesn't do it there, he's going to end up working on it in a less favorable environment. They didn't shame him or threaten him. And so of course he calmed himself down, and even proposed in the end that they enroll him in an anger management class. Such initiative!

He continues to be so emotive and alive. He writes the most beautiful letters - the one today said "I can honestly say you are the best parents I ever had and I never had real parents who were there for me me the way you guys are." I am so happy that he understands that in being apart right now, we are there for him more than ever. I am as proud of him as one could ever be.

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