Self Medication vs. Sobriety

I've been reading some posts on the NAMI group site on Linkedin and I wanted to express what worked for our family on this issue.

My son has a dual-diagnosis and we went through at long stage in the beginning where he would self-medicate, too. We used some behavioral management using ABA (Applied Behavioral Analysis) with him as well as having probate conseratorship (we controlled his money) as well as had him attend a day program that support sobriety (AA, NA, MA) and with time we were able to decrease his use which allowed his meds to work more effective, which started to give him more self-perspective, which lead him to stop self-medicating.

Our strongest rule was that he was not to self-medicate in order to live at home ( he wanted to live at home because we made it so nice for him to stay. We gave him something that he didn’t want to lose = motivation to comply.) If he came home high or drunk, I would just remark to him that he looked stoned, drunk, etc, smelled, eyes looked dilated and that he would act weird when he would come home under the influence. I even taped him once and played it back for him when he was sober. He didn't like that we would notice that he was high, that he wasn’t getting away with anything, so eventually he stopped.

Plus the next day I would be sure to have the family get up early and do one of his favorite activities. Even if it was just going out to breakfast, he would either not be able to attend and miss it (and we would talk it up to him later ), or he would be 'hung-over' and couldn't enjoy it very much. It was a long process and we reinforced small improvements along the way and was also supported by the day program organizations outside the family as well.

He ‘earned’ extra money (in the beginning it was gift cards for his favorite restaurants, etc. then he was able to move to money rewards by earning our trust through his gradual change in behavior) by attending these sobriety meetings and more if he shared and participated in them. He would bring home a signed note (which at the start of this I would call to confirm the signature) and he would give it to me for extra cash. We are a dry home to also support his sobriety. So he was heavily reinforced through this process to make the right choice and stay sober.

Eventually we would raise the bar in order for him to earn extra money, he would only get extra cash at the end of the week, two weeks, then a month for being compliant to sobriety and we did eventually extinguish the money reinforcement all together now since he is no longer self-medicating. We now are finally able to do family functions that he really enjoys without the drugs. His medication, since he’s been sober, has had a big impact on his insight also which helped him stay sober, too. So it’s an upward spiral effect. Not easy, but it is effective.

I've read several books about dual-diagnosis that were helpful in defining what it was and deepening our understanding, but nothing really addressed changing the unwanted behavior we were experiencing at home. Nothing that could help keep us together as family through this process. That came through Applied Behavior Analysis. Where there is a consequence (Good or Bad) for our actions. By tailoring them to our son's needs we were able to eventually have him make the realization that self-medicating wasn't working for him. For us, that was the pivot point that really helped promote change and the other organizations were then support services.

I hope this helps other families and their loved ones who are suffering from varrious levels of a mental illness find their solution.