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.

A Happy Unending

The short version is: T has decided to go to residential treatment and we've got the wheels in motion to get him into a really good treatment house next week. They specialize in "dual diagnosis", which, for the layperson, means they don't treat substance abuse in isolation and instead evaluate someone's full psychiatric, educational and vocational needs. It's the kind of place you go when things are falling apart on more than one front. And that's where T has been lately. Expelled from school, placed on probation, anxious, drinking and getting high every day; he's been in a downward spiral for some months.

We had to call an emergency status meeting with DCFS and their advisors (Department of Mental Health) to get to this point. It was a very uncomfortable meeting. I didn't think T would go - he had been awol for days beforehand. In addition, I don't trust his primary caseworker, who still has most of the decision-making power regarding his placement. There were a lot of people in the room we've never met before. They are part of a large bureaucracy that (in our experience) has trouble recognizing foster parents, including pre-adoptive ones, as something more than babysitters. We have no legal status in terms of our right to make decisions regarding T. We can only make suggestions. It was hard and somewhat humiliating.

I called the meeting because I was out of other options. As Tim and I noted later that night, it felt a lot like that movie where Denzel Washington chases down a runaway train by racing down the track in reverse and hitching his locomotive to the full weight of the larger train and tugging in reverse against the odds. It was a crude and imperfect strategy, but we were trying to leverage the physics of the enormous DCFS bureaucracy to stop T's self-destructive momentum. And just at the moment when it seemed like we'd all go down in a big messy tangle, it was as if T woke up from a slumber, looked around, and applied the brake himself.

The strangest part of all of this that I will never be able to fully understand is that the moment he decided to get treatment, he returned to himself. I know this is fragile, temporary and not to be trusted, but it's also awesome to observe and it was the key missing ingredient that opened up a host of opportunity. He calmed down, started communicating; he was warm, reasonable, and confident. Because we have to get a judge's order to put him in residential treatment and the judge can't see us until next week, he elected to go to a group home in another county for a long weekend to remove himself from the influences - the friends, the places, the teenage social pressures - that have been facilitating his decline. He made this decision with a maturity and wisdom I have seen in him before, but not for a long time.

Before the meeting, I sat T down. He was drunk, high and angry, but it was becoming hard to catch him sober during waking hours so I went for it anyway. I told him "You are not going to like some of the things you're going to hear me say in the meeting tomorrow, but I need you to be there and I want you to know that I love you very, very much and I'm going to say certain things in order to make certain things happen so that we can get you some options." I told him I planned to ask that they provide him with residential treatment, and that we had researched a particular program we felt good about. He skimmed the pages of the website we showed him. He looked at me through his haze and said "Do what you think is best."

The next day he was ready to go at the appointed time. He looked surprised at the formality of the meeting when we arrived - nearly a dozen adults sitting around a conference table with name tags in front of each. I cried when it was my turn to talk, and I gave a brutally honest explanation of his recent behavior. I explained that his "status" with us (DCFS talk for pre-adoptive foster placement in our home) was not in question , nor had our commitment to him changed in any way, but we felt he needed to get help beyond what we could provide on our own.

He spoke next. He was warm, awkward, and engaging. He said that he needed to get away for awhile and remove himself from his peers. He explained that he wants to be a nurse some day, and needs to go to college, but he's having trouble making decisions and keeping himself safe right now. He said he thinks something is wrong with his ability to control himself. He said he won't go to therapy if its up to him, but he'd like to go to a place where he has to go, where he doesn't have a choice. At first, they couldn't believe their ears. Judging from the looks on people's faces, he may be the first teenage boy in the history of DCFS to speak articulately in a status hearing about his desire for residential drug treatment. Afterwards, one of the more cynical people in the room told me "He sure is charming, and that's probably part of the problem." I told her she's wrong - I haven't seen him be that articulate in months. He wasn't doing it to be charming - he was using the better part of himself to get help. It was admirable, not suspicious.

In order for him to help himself, I have to separate from him and let him go and accept the risk that it may not work, and/or that he may not be home for quite some time. On some level, I have to recognize that I've failed--not through any fault, but just because he needs more than we can provide at home right now. It feels very...umbilical, to separate from him in this way. I have to recognize that other people will have the authority to guide him and I won't necessarily have a say. I won't be there. We'll be in touch, but he'll be making his own way, and it's sure to be very difficult for him. He'll have to lay down new circuitry for himself based on his own strength of character and the help of professionals I may never meet. He'll be home someday - but we won't know exactly when, and there's risk that this doesn't work for him. I am typically very logical and I knew quite clearly throughout the last couple months that we needed to get him to treatment. But actually seeing him off and giving up our daily life together at home is literally gut-wrenching.

I feel very much like a mom, in a way I never have before. I think it must be a most maternal experience to give up a child to a risky next step with fragile hopes for his future. And also to do so in a way that hurts terribly and yet fills you with the greatest pride.

T Day

A mid-week aside:

Early on, we established "T Day" - which came to be days on which he volunteered at a local hospital. Although he was interested in and agreeable to this after-school activity (because his ambition is to be a nurse), volunteering also felt a little nerdy to him and it often left him tired at the end of his shift. So we invented "T Day": volunteer days became "T Days"--days when his will dictates our other plans, within reason.

He has since stopped volunteering but the "T Day" tradition survives. Now that he's in twice-weekly therapy and grappling with difficult memories, he has decided that therapy is his official after-school activity (fair enough!) and that therapy days are therefore "T Days". (Often, his logic is irrefutable in this way.)

On "T Day", he gets whatever he wants. Thankfully, his desires are modest. He wants a fast-food snack en route to therapy. He wants his choice of dinner. Sometimes he wants to go to a movie later in the evening, though rarely. He wants to be allowed to stay up an extra half hour.

But most of all, he loves to remind us that it's "T Day". It gives him a sense of power. If I disagree with him on "T Day" he'll get in my face and say playfully "What day is today? Did you forget? Is it not T Day?"

He refers to it that way, using the third person. It's hilarious. For example, today, Tim forgot and balked at buying an after-school fast food snack on the way to therapy. I apologized to T for forgetting to fill Tim in. "I got it covered," he texted me back "I know how to work T Day."

Indeed. A friend once commented, "He missed out on a lot of T Days growing up. Probably every day should be T Day!" I don't think we could stomach that, from a nutritional point of view. But I certainly agree - T Day gratifies an unmet need for indulgence. It also takes the edge off the intensity of therapy.

Drinking

Long time no blog, because the back-to-school season and a busy phase at work kept my fingers from my keyboard.

Back-to-school: a mixed blessing for sure. We don't need to fill T.'s days. On the other hand, he's a junior in high school in a big city with lots of opportunities to get up to his business and a certain fragility in terms of his self-esteem.

Last Monday, we busted him leaving for school with a Coke bottle full of vodka and orange juice. How did we find this out? Well, we read his text messages. Imagine my horror when I discovered a text letting his friends know he'd be bringing some vodka 'n orange for an early morning rendezvous. Imagine how much I kicked myself for even having vodka in the house! Until now, he has been entirely averse to alcohol (but not marijuana), but it was stupid to have it around.

Had this happened last year, we would have freaked out completely. We're becoming more seasoned. After he left the house, we actually kind of shrugged and sat down to our morning coffee before thinking about whether he needs rehab or just a good grounding. In part, we've learned to manage our reactions better in order to preserve our own health and sanity. Adopting a teenager can be like going from zero to 100 mph without a period of adjustment and the g-force occasionally leaves us limp. Panic is the enemy, and no good for our partnership either.

I still didn't have the answer when I got home from work that evening. T was playing video games quietly in the tv room. I decided to just wing it. I went it, sat down close to him, and said "I think you left for school this morning with vodka in your orange juice. I don't want to argue about whether that is or isn't true. I just really want to hear from you why you did that. I'm worried and I need to understand what's going on."

He turned to me with his huge round eyes. He had a gentle sad expression. "I don't know why I did it," he said. He's not a particularly good liar, nor a particularly manipulative child. He looked genuinely quizzical. I said, "Were you angry? Have you been drinking before school? Did you hope that I'd notice?"

"I haven't been drinking," he said. "This was the first time. But my behavior has always been a problem. I don't know why. I do good in my classes, but I behave badly." He really does talk like this sometimes - in part, the "system" as he calls it taught him to be self-critical in this way. But it's also part of his personality.

"Why do you think that is?" I asked.

He made his puzzled face. Then he said softly, "I think about so many things. Like my mom is never going to talk to me again. And my brother, he's still in the system. We came in together, but now I'm out of the system and he's still in it. I think about it all the time."

Nobody planted this idea in his mind, and it's rare that he refers to his various tragedies - he despises the idea that anyone might feel sorry for him. He and I have talked about his mom and his brother a few times over the past year, but not often, by his choosing. We tried visits with his brother, but T. shut it down - the dynamic between them is extremely complicated and painful. For awhile, he had polite contact with his mom (and so did I, to a limited extent) but she flew into a rage last spring and cut him off. There is no easy obvious "fix" in this situation. It will take a lifetime to make sense of it.

We talked for awhile about the difference between teenage experimentation with drugs and alcohol and using drugs and alcohol to cover up feelings that seem unmanageable. I told him that if I feel that substance abuse has got him by the tail, I am going to step in because I love him. T. and I have gone many rounds trying to make progress on reducing his use of marijuana. Consistent limits are a necessity, but the only thing that works so far is when we ask him to modify his behavior just because we care about him. No other consequences or rewards have made one lick of difference. I offered that instead of punishment, what I'd like is a quiet evening without television or video games, and for us to spend some time talking a bit more about what's going on with him.

It was a bumpy conversation. We sat together in his room for awhile and he stared at the floor. He told me how he hasn't been able to cry since the last time he was removed from his family. I told him how I think about his birth mom a lot and feel badly that she missed out on his childhood (they didn't meet until he was twelve). We talked about how maybe his mom doesn't know what to say and how to make it right between them. By way of helping him depersonalize his mother's rage, we talked about how using drugs for a long time change someone's personality and make it very hard for them to control their anger. He told me that there's a "secret reason" why his mom doesn't want to talk to him or any of his siblings, a reason he can't share with me. We talked about some options for rebuilding his relationship with his brother, and he offered that he thought he'd like to start with regular phone calls.

I also asked him what he would do if he were the parent and he found out his most-loved child was taking vodka to school in the morning. He got a very serious look on his face - he slips easily into the role of parent/counselor and he really likes this approach. "Well," he said, "I would ask him. Did he drink it? If so, I would treat it very seriously. Did he sell it? That would be very bad, and he would have to lose his privileges and be in big trouble. But if he took it and gave it to someone else, and he didn't know why, and it was his first time, I would talk with him and try to understand him, and I would let him know that if he EVER, EVER does this again, there will be very serious consequences."

That's some childish logic, and not the final word on the subject. Obviously giving alcohol to other kids at school is totally unacceptable. But I do appreciate the progress he's making toward recognizing a connection between his use of mood-altering substances and the pain and confusion that come from the losses he's sustained.

Since our conversation, we've had nearly two weeks of much more moderate, relaxed behavior. Recently, he asked me to fire our therapist. "We do our own therapy," he said. "She doesn't know me." (In another post, I'll write about our frustrations with therapy and the general lack of services for teenagers like him.) T. makes me realize all the time that all that keeps us from falling off the edge sometimes is knowing that we don't want to hurt or disappoint someone who's opinion we care about, someone we feel really knows us. We can't fix what's happened or stop T. from feeling deep grief about everything he's lost. But we can sit with him, know him well, be honest with him when he's off-track and let him be honest with himself.

Insisting on the Right to Parent

Well, we had high hopes for the wrap-around service we were referred to by our beloved adoption caseworker. (Wrap-around is a model for counseling and support for foster and adopted kids. There are different tiers of wrap-around and it can be very intense - a team of behavioral specialists who support the parents and the kids, often through crisis periods.) We aren't in a crisis, but we thought it would be good to be proactive and get involved with some of the support services available to us through the county, and our social worker thought this program (through a reputable mental health organization) looked like a good bet. (The county only funds certain mental health models - due to budget cuts - so getting a family matched to services is tricky and our caseworker was being creative.)

Mostly we were hoping for a good in-home family counsellor to help us sort through issues like birth family contact, past trauma, and the day-to-day parenting stuff like how to get T. to eat something other than a cheeseburger. We've never been parents before, and we want to rock it.

Like many aspects of the foster/adopt process, the wrap-around program sounded good and turned out to be quite awkward. I think the problem is that the wrap-around team had a one-size-fits-all approach. They kind of stormed in, with a "parent advocate" (someone to counsel us); a "behavioral specialist" (someone to counsel T.); a "team lead" (a CSW to head the team), and a therapist. They brought flip charts. They told us they had 30 days to work through various "assessments" and that we'd have to commit to weekly 90-minute meetings and some interim appointments. They started out with a "strengths assessment", asking us all to identify what each of us brings to the family - that part was fun. I thought, hey, this is going to be great! Then they moved on to the "safety plan" - that's when things started to veer off course.

I started to suspect this wasn't going to work out one afternoon about two weeks into it. T. had a root beer and it exploded in the car and got all over his clothes. He totally unraveled - rocking back and forth and moaning "I'm going to lose my mind!" He REALLY cares about having a neat and clean personal appearance, but his reaction was out of all proportion. Our conversation eventually came to the wrap-around appointment we had later that evening. Finally he burst out, "I don't need wrap-around! It's not for ADOPTED kids! It's for kids in GROUP HOMES! I KNOW what wrap around means! It's for PSYCHOS!"

T. is never melodramatic, so this outburst was most unusual. Although his perceptions of wrap-around might not be accurate, they are informed by a brief, terrifying stint he did in a group home before he was placed with us, where he was surrounded with kids with very serious problems with crime, gang involvement, drugs and truancy. He knew that wrap-around was an attempt to stabilize those kids, and he felt deeply insulted and worried that he was being addressed in what he saw as a similar way.

I am all for safety planning. Traumatized kids often have dangerous behaviors and identifiable triggers. And T. DOES have behaviors that concern us - a marijuana habit we've been working on, a tenuous connection to school, and some "friends" who use him. But he's in a good place right now. He's getting good grades. He's abiding by our rules. He's communicating with us openly. We gave him a crystal clear set of rules when he moved in with us, regarding the teen triumvirate of drugs, violence and sex, and he has done an astonishing job of working with us to make smart decisions for himself. The safety plan involved meeting with the whole team (three professionals, plus the family) to fill out a form where we were to fill in the blank for categories like "dangerous behaviors" "triggers" and "resources - ticking off whether we'd call the police, the fire department, or the social worker in response to whatever dangerous behaviors we came up with. It made T. feel like everyone thought he might hold a knife to our throats.

When we tried to guide the process in a way we knew would secure his buy-in, the team lead implied that we were naive and that they knew of "certain information" in his case file from his adoption worker that "raised red flags for them." They wouldn't be explicit about that information unless we agreed to come into their office with T. to meet with a "supervisor". I hate this sort of innuendo and veiled threat. We are hand-in-glove with his adoption worker, and there is nothing in that file that we don't know, and very little that we didn't unearth ourselves. None of us felt like they could hear what we were saying.

We cut it short. Our caseworker completely backed us up. In the end, it came down to a simple realization: we are his parents. We still share guardianship with the county until our adoption finalizes, but that hardly matters in the day to day. We feed him. We counsel him. We sit with him when he needs to talk. We take him to visit his birth family. We tolerate his annoying attitude during holidays when he feels confused about his relationship with us versus his birth relatives. We know his friends, and whenever possible, their parents. We talk him down when he's upset, and we laugh with him when he's being hilarious. We play tickle games, we snuggle on the sofa, we wash his clothes, and we call his teachers to check up on his progress. He calls us his "fam bam" and his "peoples". Nobody is going to come in my house and tell me they know more about what he's up to and what he needs than I do - especially before they take the time to know him.

I expect that other foster/adoptive parents feel some days like they're being second-guessed by social workers, mental health providers, teachers, counsellors, etc. No disrespect to those who labor in the trenches to help abused kids - I am the first to sing the praises of our absolutely amazing DCFS adoption worker. But these kids can come with a small army of well-intentioned "experts". Sometimes I find I want to please them - sometimes (I'm embarrassed to say) I find that secretly I want to impress them. But the only thing I have to do is be a good parent to T.

In the beginning of the placement process, it's complicated - you're getting to know the kid, his history and his needs. But there comes a day when you've made a total commitment to this kid, and you have to insist on your right to do your job as the parent. If someone offers him the wrong kind of "help", or forces him to fit a model that isn't aligned with his behavior, they have to contend with me. Getting between him and adults whose attention isn't benefitting him is part of how I show him what it means to really have a parent.

In the end, we said to him over dinner "We don't feel like the wrap around service is working out and we're ready to call it off. How do you feel?" He rolled his eyes and said, "I could have TOLD you that last week!" And that was that. That evening he was visibly relieved, resting his head on my shoulder while we sat on the sofa and chatted with Tim about music. We were alone, at home, doing regular stuff, and that was just fine.