Substance Abuse Question

I know this is a sensitive topic, so i tried my best to research before asking.

Context:
My MC has 2 older brothers. the oldest one is angry and jealous because their grandmother is helping to put my MC through college. he feels that their grandmother "doesn't give a damn" about the other 2 brothers and that the youngest brother is just trying to get money off the grandmother.
Toward the end, the middle brother reveals that their grandmother was helping him through his addiction and paid for a his substance abuse program.

my question:
Are substance abuse programs (like alcoholics anonymous and other 12 step programs) free or do you initially have to pay for treatment?

Its ok if you don't go into details if you don't want to. You can simply leave a "Yes/No free" or a "Yes/No Pay"


(PS. every time i google, no matter how i phrase my question, i keep getting the "SAMHSA's National Helpline" phone number)

 

Alcoholics Anonymous is free. They are not (IMHO) "treatment." AA (and NA -- Narcotics Anonymous https://na.org/?ID=PR-index ) are support programs, not formal treatment.

 

Different jurisdictions, yours and mine but I figure AA and NA run similarly enough this side of the great pond. While both hold to the 12 steps model, people who attend don't really follow a programme, as such, in that there's no start and end as there would be with a structured programme. They run as peer support for recovering addicts and can be an important part of recovery, included in a structured programme, but people often dip in and out, attend different meetings in different locations and hear how others manage their recoveries.

Structured programmes can be residential or day programmes. If your character was in residential, his brothers would probably have noticed his absence. Again in Ireland, attendees must pay for treatment programmes though this can be arranged in different ways, including a beneficent grandmother. Payment, for many programmes, will not obstruct entry and can be arranged through instalments, granting social welfare cheques during treatment, health insurance or, if referred by a government agency, payment by that agency for people it might refer. The agency I work for makes payment to a number of residential treatment centres to reserve beds for clients. Aside from the regular, I'm sure there are exclusive clinics that can charge big numbers for their exclusive clientele.

In answer to your query, a generous grandmother could well be an important resource for an otherwise impoverished addict to attend a treatment programme.

 

I googled "is AA free -samhsa" and the first result from the AA FAQ is:


"How much does AA membership cost? There are no dues or fees for AA membership. An AA group will usually have a collection during the meeting to cover expenses, such as rent, coffee etc, Members are free to contribute as much or as little as they wish."

In the U.S., while not treatment, at one time participation in a 12 step program could be mandated as part of a condition for court approved release, at least according to Penn and Teller, who opposed it as a violation of the principle of separation of Church and State. Not sure if that is still the case.

 

I found AA completely worthless. The free coffee and day-old pastries were nice, but there was nothing of how to survive and end alcoholism (nothing effective anyway) other than the war stories of how Susan B hid her drinking from her family, or how Bob J got away with drinking on the job. I suppose there was a sense of camaraderie-that knowing you weren’t alone. For me it took that solid smack on the proverbial rock bottom to change direction. I haven’t had a drop since and I don’t miss it. Cold pizza and warm beer for breakfast may have sounded reasonable when I was young, but that’s no way to go through life.

There is a newer idea in addiction treatment that’s been going around in the past couple years using hypnosis to replace that resolve to stay clean. Hypnosis can’t make an addict not use, but it can help bolster the desire to recover.

 

hmmmm....

My MC, his brothers, and his grandmother arent too well off. They are on the poverty line.... but the grandmother does whatever she can and gives what she can so that her grandchildren will be ok.
My MC wants to go to college and works 2 jobs, and the grandmother gives him money, too (he reluctantly acepts this)
the middle brother is struggling with addiction (@B.E. Nugent, he is pretty much absent after the 4th chapter but comes back toward the end, so inpatient/resident would account for the missing time). The grandmother doesnt have much, but she wants to help him, too.
the oldest brother... lets just say, despite all she's done for him, he's beyond her help.

since it seems like both inpatient and outpatient programs/centers are pricy, in what other ways could the grandmother help the middle brother if not financially?

 

Again, some things work differently here than in the US. But...

There are addiction treatment centres operated by religious organisations that focus more on flock welfare than profit margin. Sometimes these can be dubious but can work for some people, particularly if they are disposed towards replacing drug of choice with prayer and God. Not for everyone, nor most in my experience, but could work for your character. Maybe. Grandmother could be close to the pastor who is patron for the clinic.I

Something that does cross the ocean between us is the importance of human relations in such matters. Grandmother could be in a position to call a favour from director of a treatment centre, maybe nanny for his kids all those years ago and a lingering benign relationship so her grandson is accepted pro bono or nominal fee. Hell, it's probably tax deductable. Might also put flesh on lengths gran will go to protect the brothers?

Hereabouts, residential treatment centres will often involve family members in the programme, usually weekly visits for often challenging group meetings. Grandmother's input could be covered by her facilitating this piece.

Not sure how real you want this to be. She could accompany the kid to the centre and beg, pawn the heirloom that turns out to be cubic zirconia. Pathos. You can go lots of different directions, I think.

 

This is a difficult question, because often what the giver perceives (and intends) as "help" is effectively just enabling. I have been through that, with my first mother-in-law (an alcoholic), and then with my late wife and her enabling support of her granddaughter (who is also my adopted daughter). A good friend has the same problem with his adult step-son, who is a drug addict and a serial recidivist. Problem number one is that addicts lie. That's a blanket statement, which we're not supposed to make. However, when dealing with addicts, it is a fair and safe statement to make, because it's a universal truth. They lie -- period.

They always have a sob story, and they'll cheerfully bleed a relative (even an elderly grandmother) completely dry and then, when that person has nothing left to give, they turn their backs on them and seek out someone else they can sponge off of for as long as that source lasts.

And it's NEVER their fault.

So ... Granny could help the addict grandson by allowing him to live with her. In which case he'd probably steal any money in her purse, and gradually pawn anything of value in her home. She could buy him food. Giving him money would not help. My first wife and I went through that with her mother. My wife would send money for food, and the money would be spent on booze. We were several states apart. In the end, we resorted to sending money to my wife's sister, who lived close enough to their mother that she could buy groceries every week and deliver them.

Granny could buy him clothes -- but nothing new, because he'll sell anything new to pay for his next fix.

It's very difficult to help someone who isn't ready to be helped. Unless and until an addict has truly hit rock bottom and decided to get clean, their entire life is devoted to getting the next hit. To do that, they will lie, cheat, steal -- and they have no compunction about lying to, cheating, and stealing from their own relatives.

 

I did some research on this for my 3rd book about a rock star who had just gotten out of rehab. The facility I picked was The Meadows Clinic in Phoenix, because of the number of celebs who have been treated there (Elton John, Ronnie Wood and Whitney Houston to name a few). According to my notes inpatient care at the time was around $1000 per day back in 2014.

 

He's hit rick bottom. Thats why the grandmother is helping him.
She's helping her youngest grandson with college because he wants a better life. Shes helping the middle grand son because he wants a better life and is willing to change for it.
Only one who is mooching off her and stuck in his ways is the oldest grandson.

So the alcoholic grandson is willing to change and get help before things get even worse for him.
The story isnt about him, so there isnt details about his addiction or his struggles. His drinking habits are hinted at earlier on and then He's absent after chapter 4. He comes back later revealing that the grandmother has helped him in his time of need which serves to show the oldest brother that the youngest one-- my MC-- isnt taking advantage of the grandmother and isnt "the favorite" because she's been helping the other brother too.

I just want it to make sense with HOW shes helping him. It seems like a rehab center isnt an option anymore.
Letting him.live with her isn't an option because she has no room.

And i cant nix that whole thing and have her NOT do anything, because having it known that she helped him in some capacity is important to the plot.

 

Rock bottom is a very subjective term. If your character is on that spiral, he'll find each rock bottom is also a trap-door, or at least a false bottom. There's always new depths of desperation and depravity. However, not everyone dealing with addiction follows the same path. People can, and do, arrest the descent, reach a point and decide enough. Then do something about the problematic substance use. Sounds to me like that's where your background character is coming from, where he's ready to respond to the support offered by his grandmother.

There are certainly things she can do that are not enabling without being condemnatory either. There are things this guy will take from his grandmother that might get someone else a punch in the face. She could have spent the nights with him, talking through his distress, challenging him, helping to point him in a positive direction. Addiction centres will all speak of people, places and things. She could find a relative able to take the kid away from the people, places and things that contribute to his drinking. She could access a farm or co-operative arrangement or wildlife preserve or something that pulls him out of his destructive milieu. And he could mess it up or take the opportunity on offer. You know your character so you know what might work for him.

Final note, my mother-in-law, RIP, was a quiet, reserved woman, described complimentarily as a "lady" by neighbours and friends at her funeral. An apt description. When her only son was in his teens, she went to every pub and off-licence in the little town and warned each and every proprietor that she would report them to the police if they ever sold alcohol to her underage son. She never had to go through with the threat. The grandmother in your story sounds resourceful and fierce in her own way. The kid dealing with substance use sounds like he's primed to avail of the support on offer. He's young, so maybe things have not got so bad that he's lost all control and her intervention can still have a significant impact. It's a side link with an important element for your story. Maybe the intricate details of how exactly she helped are less important than broad strokes that she intervened in a positive way?

 

I like @B.E. Nugent 's idea of having social or human capital to call on if grandma doesn't have much money herself. I also wonder if they could take advantage of someone's insurance? Like maybe grandma retired from some government job (the post office?) that never paid much but left her with some by-today's-standards sweet health insurance, and the kids are her dependents so they're on it as well?

Coincidentally my brother works at an inpatient rehab facility of the decidedly not-Elton John level, and I don't think they'd be in business if their clients had to pay out of pocket.

 

Years ago a woman in one of my writing classes told the story of her son who was addicted, broke, and living in his car, which didn't run very well. She didn't dare let him live at home because she'd learned from hard experience that his presence endangered the well-being of the rest of the family. Every week or so, she'd pick him up, buy him some groceries, take him home for a shower and to do some laundry, then drive him back to his car and leave him there. It broke her heart every time, but that was all the help she could safely give her child. I've always wondered what became of him and her. Sometimes people simply will not not be saved, and no amount of love, effort, or money paid to rehabs will change that.

 

I knew a woman who had two sons. One died when he was in his teens or early twenties. The other went to druggie route. My friend tossed him out of the house and told him not to come back until he was clean.

Some twenty or so years later, she retired from her job as a school librarian and retired to a modest home in a small town in northern New Mexico. I visited her there twice. A couple of years later, the wayward son showed up -- clean. That was at least ten years ago. We've lost contact but, last I knew, the son had remained clean and had found a real job. I know the tough love approach was extremely hard on my friend, but she believed it was the right way to go. Perhaps she was right.