Recently I met with two women to plan a program on families and addiction.  I’ve worked with both of these people before on similar programs, but this meeting was different.  This time they were talking about themselves and their respective adult sons, both of whom have long histories of alcohol abuse, and both of whom now live hundreds of miles from their parents.

One of them has been doing well, maintaining sobriety for a couple of years and holding a job, but the other is unfortunately in crisis. He has had several encounters with police and spent time in jail; criminal charges are pending. He’s unemployed, recently lost some good friends to cancer and suicide, and now talks about suicide himself. The mom of the son who’s doing well for the moment is cautiously hopeful: Although this is his longest period of sobriety in years, her son could relapse at any time, as he has before. The mom of the son in crisis is living her worst nightmare, often on the phone with him in the middle of the night, not knowing exactly what his situation is and not sure of the right thing to do. This isn’t uncommon. Sympathetic listeners may be available, but they cannot provide the level of support needed. It seems logical that there should be a hotline or other type of 24-hour support service for concerned family members.  But nothing like that exists.

None of the available options is a good one. Call law enforcement? Responding officers may or may not have crisis training in handling chemical dependency and mental illness emergencies. Traditional policing tactics can escalate a situation and provoke violence, with potentially tragic results. Even if law enforcement intervention is successful, the person may end up in a county jail that is neither staffed nor equipped to handle such crises. Call an ambulance? Paramedics and other first responders are not necessarily trained for these types of emergencies either. An ambulance will most often transport the person to a hospital emergency room, where the pace and commotion or the need to wait while more critical cases are cared for may exacerbate the situation. Obtaining a specialized substance abuse or mental health evaluation in the ER – or, for that matter, in any outpatient setting – is difficult. Which raises another issue: What happens after the crisis, and ideally to prevent the next one?

A multitude of barriers stand in the way of connecting people to treatment resources, including at times their own histories. After a number of failed attempts, many treatment centers will no longer accept a repeat patient. Treatment is costly, and health insurance provides minimal reimbursement for mental health and addiction services. A patient who is unemployed and has coverage from Medical Assistance will find treatment options especially limited. Because of the high cost and lack of reimbursement, as well as shortages of specialized staff, programs are downsizing, which results in lengthy waiting lists. Data privacy laws prohibit the unauthorized release of status or treatment information on adult patients to concerned family members.

Families know all about these obstacles. They’re likely to deal with the practical realities of mental illnesses and/or substance abuse disorders over the course of months and years, even decades. They’re much too familiar with the hopefulness/disappointment/worry/fear cycles that replay with every crisis. They awaken at night wondering if the next crisis is imminent, if it will be the last one, and if so, how it will end.

The hardest thing for me to hear from these two moms was the sobering statement, “People just don’t know. They have no idea.” Nonetheless, many are eager to offer advice: “Use tough love. You’re just enabling him by bailing him out.” “There’s nothing that can be done as long as he doesn’t want to change [or keeps making bad choices].” “You have to take care of yourself.” Such comments miss the mark in so many ways. Many simply underscore the pervasive and persistent stigma of mental illnesses and addictions as moral defects or the result of faulty parenting.

Is there nothing more we can do? What if the real message is that society has already decided that these loved ones are throwaway people? Is it because they are considered too difficult, costly, and frustrating to treat that the barriers to treatment have not been eliminated? That’s a truly chilling thought. Especially if it’s your son that we’re talking about.

Jo Glasser is working on a book for publication by Blue Ear Books. She lives in La Crosse, Wisconsin.