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Does he need treatment or an attitude adjustment?



We hear a variation of this question from most families we talk to and we want to explore this idea deeper so every family can see the many factors that influence how family members experience, view, and approach a loved one who is struggling.

The suggestion that someone needs an attitude adjustment (or stricter boundaries, or harsher consequences, or a kick in the butt—however you choose to express it) implies that what’s happening is a behavioral issue and reduces it to a series of bad choices your loved one is making. It also implies that what’s happening is that young man’s own responsibility to fix by sheer force of will. Some families feel uncomfortable about the reality of a substance use disorder and the long-term social, academic and professional hurdles it signals.

But it also reveals a common thread amongst family members who want the issue contained: whatever is happening, they would prefer to fix it at home without outside intervention or disrupting his life and theirs.

If this is your first time exploring treatment options, it could be hard to articulate what’s going on beyond something not feeling right with your loved one—a typically bright, funny, charismatic young man whose light seems to have faded and you don’t know why. You might be experiencing his changed behavior first-hand if he’s living with you, but if he’s living with another parent or in another state, you might be picking up clues and context cues that are more subtle and nuanced. It can be hard to know what’s going on, and harder still to get your co-parent on the same page.

What’s your experience of his situation?

In our first conversations with families, we like to discuss not just his history but also your experiences of his behavior. Getting a family history and background provides us with insight that shapes our treatment recommendations.

Parents have described a broad spectrum of behavior and context to us, running the gamut from tense conversations and deception to encounters with the law or periods of hospitalization.

Some young men are detached or unreachable for days on end, never picking up calls or returning text messages. Some become angry or violent, lashing out at family members or others close to them. Some are high-achieving students, athletes or professionals whose performance has suddenly nose-dived. Some act recklessly, taking risks, breaking rules, or even breaking the law.

Family members, even in the same house, can have differing experiences of his behavior, disagreeing on how serious the problem is and how intense the intervention needs to be. When we have these discovery conversations together, we can help you lay out your experiences and insights in a way that paints a detailed picture, providing vital context and insight.

It’s normal to want to minimize

An important caveat for families reading this article: if you have caught yourself minimizing, normalizing or shrugging off his behavior, you are not alone.

It is normal to wish for this to be “just a phase” or that he can “go back to the way he was” or for his substance use to be “just experimenting”.

Let’s put a big mental asterisk on all of these ideas that seek to minimize what’s going on. Consider that by the time they’re high school seniors, most students (around 70%) will have tried alcohol and about half will have tried drugs. In other words, most young men in their early 20s first came into contact with drugs and alcohol years before now.

Is it possible that what you’re seeing is him experimenting with drugs or alcohol for the first time? Yes, it’s possible. But it’s statistically unlikely and in a more practical sense, it’s a dangerous assumption if it causes you to delay taking action.

Many family members feel drive to help their loved one in tandem with the desire to not upset the delicate balance of their relationship with him. There’s a strong urge to choose options that aren’t disruptive to his school, work or lifestyle. At Voyage, we think that interrupting his current lifestyle is an important step towards building a healthier one.

Substance use disorder is diagnosable

This is maybe the single-most important factor to consider if you’re a family member who’s asking some variation of the question “does he just need an attitude adjustment?”

Substance use is a more complex issue if it’s a traceable pattern, is causing social, physical or mental health problems, or puts him in risky situations—like something that could get him hurt or arrested. When these outcomes start to cluster together, coupled with repeated, prolonged substance use and the belief that he can't function without drugs or alcohol, we look at the possibility of a substance use disorder.

Substance use disorder is no one’s fault

Having a substance use disorder is not a character flaw or a moral failing on his part—or yours. It's a chronic illness that should be approached with the same compassion and clinical skill as any other disorder. You can allow yourself to re-frame his behavior in the context of a medical illness.

It may also help you to understand there are a variety of risk factors that might increase his vulnerability to a substance use disorder. One of the most significant contributing factors to developing a substance use disorder is genetics—things like a family history of substance abuse or mental illness. Co-occurring mental health disorders can also be an important contributing factor—depression, anxiety, bipolar, or ADHD often show up alongside substance use disorders.

There are also environmental factors, like early exposure to trauma, acute or chronic stress, growing up in a home where alcohol is easily accessible, or going to schools where there is a high prevalence of drug use. Our brains are wired to repeat behaviors we need to survive, or that make us feel good. Drugs can hijack this process: prolonged use can lead to an irresistible compulsion to keep using, even if the consequences are severe.

No one can choose how their brain and body will react to drugs and alcohol in the short-term or over long periods of time. Many substances have a pretty immediate effect on brain chemistry, and those changes will directly affect his behavior, personality, and his judgment— which is why it’s vital to distinguish between addiction and bad behavior. An attitude adjustment can’t undo the effects of prolonged substance use.

Substance use disorder is treatable

At Voyage, one of the most important and effective therapeutic approaches we use is cognitive behavioral therapy (CBT). As far as evidence-backed approaches go, this one has significant evidence of its efficacy, both in research and clinical practice.

CBT is based on the principles that psychological problems, including depression, anxiety disorders, alcohol and drug use problems, eating disorders, and severe mental illness are based on faulty or unhelpful ways of thinking, on learned patterns of unhelpful behavior, and that patients can learn better ways of coping, thereby relieving their symptoms.

We dive deep into distorted thinking, behavioral patterns, and sharp-edged emotions in a safe and supportive way, helping him examine old beliefs critically and make decisions about how he’d rather live. Individual therapy is a vital place for discovery, and group therapy helps our men learn to seek support and accountability from their peers, while living more honestly, openly and vulnerably.

Therapy at Voyage leads a man through introspection and self-discovery, processing his feelings in real time, and learning how his thoughts, feelings and memories affect his behavior. It’s an approach that shows him how his emotions and behaviors are connected—that how he thinks affects the way he feels and the way he acts. When negative feelings show up, we hold

them up to the light, challenge them, then help him construct new patterns that honor the man he wants to be.

The best time to look for treatment options

Here’s the truth about treatment: it’s going to be disruptive. It’s going to interrupt his life, and whatever he has going on at the moment, whether that’s college or a career or a relationship. But this disruption is a good thing.

Some families believe that he needs to “hit rock bottom” before he can get help. No matter how high or low his bottom, he’s not going to get any better in a sustained state of relying on drugs and alcohol to get by. And the lowest of bottoms can be truly tragic.

We’ve seen that the sooner families intervene, the better the chances their loved one has of lasting recovery. The sooner we can help him break from his old patterns and help him and your family begin to heal, the sooner you can begin the “recovery” phase of your life.

Voyage admissions is a thoughtful and measured process—we’ll ask you for a lot of background, as much detail as you can provide about his physical, mental and emotional health, about his relationships, his commitments and responsibilities, whether he’s enrolled in school or in a career, his medical history, and your family history. We’ll want to know if he’s suffered any kind of trauma, if he’s had periods of hospitalization, and we may want to speak with anyone who has treated him previously. Our goal is to create a richly nuanced profile of your loved one so we can determine if Voyage is the right place for him, or if he’d be better suited to a different kind of facility or approach.

So what about that attitude adjustment?

The Voyage approach combines sophisticated, evidence-based clinical services with an innovative experiential program. He’ll live in our beautiful, well-appointed residence with 14 other young men who are also in early recovery, sharing a bedroom and common spaces.

He’ll stand shoulder-to-shoulder with his peers every day, listening, learning, healing, leading, and working together as they all share the journey to recovery together. He’ll be put to the test regularly, put in situations where he’ll have to face uncomfortable thoughts, feelings and memories and push his mind and body to its limits.

And he’ll do it all without any access to the substances he’s been using to cope. No part of his daily life is going to feel like life before treatment, but it’s going to lay the foundation for the most important adjustment of his life: his transition into a man in recovery.

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