My Child Is Using Drugs or Drinking Alcohol—What Should I Do?

By Kim Abraham, LMSW & Marney Studaker-Cordner, LMSW

You thought your son was just “experimenting” with drugs, but had stopped. Now he’s failed a drug test for his work–study program at school, and you know: this is serious. Your teen daughter is hanging around with kids who are notorious for drinking and partying on the weekends. She’s come home drunk twice this month. This morning you found vodka in her room. What do you do? The following is an excerpt from Life Over the Influence, a new program created by Kimberly Abraham LMSW and Marney Studaker-Cordner LMSW, therapists and experts in helping families who are struggling with substance abuse issues.

There is a difference between rescuing your child and going to the other extreme of giving up.

If you’re reading this article, you’ve got pretty good reason to believe your teen is abusing substances. Rather than focus on getting your teen to admit he’s using, or the degree of his use, we’re going to focus on what you can do to respond to the issues that result from that substance use.

Teen–proof Your Home

The first thing you can do is be proactive. Remember when your child was a toddler and you put baby gates across the stairs, locks on the cabinet doors and you put all your breakables out of his reach? Well, it’s time to teen–proof your home now. If you drink or use substances, lock it up. Or better yet, get it completely out of the house. If you have prescription medications, lock those up too. Don’t assume that just because your teen is using one substance, he’s not open to getting high in a different way.

You may be thinking, “This is my home, I shouldn’t have to lock things up.” Would you have said that when he was a toddler? “This is my home! I shouldn’t have to put the poisonous cleaners in a locked cabinet just because he’s two.” Your teen is still a minor, and whether you should have to teen–proof the home is beside the point. It’s still a part of parental responsibility, and it’s something you can actually control.

I’m Afraid of What I Might Find in His Room. Besides, it Smells in There….

Parents often wonder where to draw the line with privacy when a teen may be using substances. Remember, this is your home. Privacy is a privilege. Is it a good idea to read your thirteen–year–old’s diary just because you’re wondering if she’s mad at you? Of course not. But if you suspect your teen is using substances, privacy goes out the window. It’s your home, and your right and responsibility to make sure illegal substances are not in your house, because you will be held responsible. That’s real life. If you had a tenant, and thought he had drugs in the room, would you say, “Oh, I don’t want to upset him by invading his privacy.” Of course not!

If you find substances in your child’s room, you will have to decide what course of action you’re going to take. You know your child best. It’s a judgment call as to whether or not you should call the police. If it’s the first time you’ve discovered the substance, you may decide to flush it and let your child know, “Look, I found pot and I flushed it. If I find it again, I’m calling the police.” If you’re concerned the substance abuse has reached a level where the court should be involved, you may choose to call the police the first time you find it. The type of substance found may also play a role. If you find liquor, that may strike you differently than if you find heroin. Even with liquor, he can be charged as a minor in possession. Make sure you are prepared for the court to be involved if you call the police.

Many teens will actually have the nerve to be angry at their parent for flushing their stash. They may even tell you, “Hey, you owe me money for that!” You can respond calmly and let your child know, “Would you tell the police they owed you money if they took it? This is real life.  If you bring it into my home, you’re going to lose a lot of money, so make an informed choice.”  By doing this, you are starting to make substance use uncomfortable for him, and you are establishing a firm boundary.

I Need Some Weed…Can I Get Twenty Bucks?

If you know, or even suspect, that your child is using substances, one of the best ways to put a wrench in his buying is to cut off his cash flow. Now is the time to close the First National Parent Bank & Trust. Don’t give cash for things like movies, lunch, clothes. Write a check or pay the school directly for lunches, or let him brown bag it. Buy the clothes yourself. Don’t give cash for birthdays or holidays, or big–ticket items he can pawn or exchange for drugs.

That doesn’t mean you can’t do anything for him for special occasions. You could offer to take him to a movie or an event—something he can’t cash in to support his use. If you start to feel guilty for not giving money, remind yourself that any cash could go to support his use, and you’ve made this decision in his best interest.

In this day and age, many kids act as if it’s their right to have money. It’s not. It’s a privilege, one that’s lost when substance abuse is involved. And it’s something you have complete control over: no one can force you to give your child money. You can tell your child, “Look, my giving you money is a privilege, based on trust. And right now, you’ve lost that trust.” This is both a natural (lost trust) and responsive (withholding money) consequence to substance abuse. It will help your teen feel uncomfortable and he will have to decide if these consequences are “worth it.”

So what can a parent do when a well–intentioned relative gives your child cash, after you’ve withheld it? Tell Grandma or Aunt Sue why you’re withholding money, and educate them on what could happen if they give your child cash: he could use it for drugs, and they could actually be supporting his substance abuse, not buying him the jeans he said he needed. You can’t control these family members, but if you’ve let them know what the situation is, they can make informed decisions themselves, and it’s not a secret. Remember real life: your child will eventually be an adult, and he may go to relatives any time he needs or wants something. They will have to make their own decisions on what they’ll choose to do.

What if your teen works and uses his own money for drugs or alcohol? What can we, as parents, do then? Not a whole lot. That’s a personal boundary, and you can’t control it. Your child’s job may actually be a positive thing for him, and he may have worked hard for that paycheck. The lesson may be, “Huh, my whole check’s gone on a bag of weed.” That’s a natural consequence, and your child will have to decide if it’s worth it to him. Again, in real–life, many people blow their money on things that aren’t good for them.

Love, Balanced with Boundaries and Natural Consequences

The difference between caring and care-taking comes down to clear, consistent boundaries. When your child was five, you were literally his caretaker. You held his hand when he crossed the road, cut his meat for him and monitored him closely. Over the years, you’ve allowed him to make more age–appropriate choices, and begin to experience and learn from natural consequences. He stays up too late, and he’s tired the next day. The lesson he learns: If I don’t want to be tired all day, I need to go to bed at a certain time. He leaves his homework until the last minute, rushes, and fails the assignment. The lesson he learns: If I don’t put some effort into my class work, I’m not going to do well. These are lessons we all learned in life as a normal part of development. As adults, we continue to learn lessons through natural consequences every day.

So why do we tend to fall back into care-taking mode when our teen starts using substances? Because it’s scary, even terrifying, and it feels like there is so much riding on his choices. Remember, the best we can hope for as parents is to prepare our kids for real life. In the real world, your child will encounter many situations in which a lot will be determined by his choices. As adults, we make important decisions every day. Your child will, as well, his entire life. If you rescue him from natural consequences now, it’s simply delaying those life lessons.

This is important: there is a difference between rescuing your child and going to the other extreme of giving up. We’ve addressed the rights and responsibilities that are part of parenting a child who is using substances. If there’s an area you’re unsure of, or if you’re encountering a particularly difficult situation and aren’t certain what your rights or responsibilities are, consult a professional therapist. Ultimately, you know your child best, and while these guidelines can help you establish boundaries and hold your teen accountable, you must use your best judgment when making decisions regarding your child.

* Editor’s Note: This article is an excerpt from Life Over the Influence, a new program created by Kimberly Abraham LMSW and Marney Studaker-Cordner LMSW, therapists and experts in helping families whose members are struggling with alcohol or drug use. This excerpt addresses a small piece of the very large issue of substance abuse. For more information on how to handle it in your own family, including how to give consequences and when to seek treatment for your child, please click here.

About Kim Abraham, LMSW & Marney Studaker-Cordner, LMSW

Kimberly Abraham and Marney Studaker-Cordner are the co-creators of The ODD Lifeline for parents of Oppositional, Defiant kids, and Life Over the Influence, a program that helps families struggling with substance abuse issues. Kimberly Abraham, LMSW, has worked with children and families for more than 25 years. She specializes in working with teens with behavioral disorders, and has also raised a child with Oppositional Defiant Disorder. Marney Studaker-Cordner, LMSW, is the mother of four and has been a therapist for 15 years. She works with children and families and has in-depth training in the area of substance abuse. Kim and Marney are also the co-creators of Their first children’s book, Daisy: The True Story of an Amazing 3-Legged Chinchilla, teaches the value of embracing differences and was the winner of the 2014 National Indie Excellence Children’s Storybook Cover Design Award.

 

Information about the law that protects your mental health and addiction benefits. Read more about these protections here.

Mental Health Parity and Addiction Equity Act of 2008

Health benefits are physical health, mental health, and addiction services paid for by health insurance plans, often called “health insurance.” Generally, the Mental Health Parity and Addiction Equity Act (MHPAEA or “parity”) requires most health insurance plans to apply similar rules to mental health and addiction (Behavioral Health) benefits as they do for medical/surgical benefits – referred to here as “physical health” benefits.

 

Health Insurance Plans and Parity

Most health insurance plans are required by law to offer parity for Behavioral Health benefits. Generally, this includes employer-sponsored group health plans and individual health insurance coverage, including MassHealth plans.

What Parity Means to You

Parity means that financial requirements, such as copays, or how many visits your health insurance plan will pay for, must be comparable for physical health and behavioral health services. Parity also applies to rules related to how behavioral health treatment is accessed and under what conditions treatment is covered (such as whether you need prior authorization from your health plan before starting treatment).

Here are some examples of common limits placed on physical and behavioral health treatment services:

Copays

Deductibles

• Yearly visit limits
• Need for prior authorization
• Proof of medical necessity

Although health insurance benefits may differ, parity requires that the processes be comparable when accessing these benefits. Please call your health insurance plan to find out more information.

Parity Protections

Here are examples of how the protections from this law may benefit you:

Plans must apply comparable copays for behavioral health care and physical health care.

There can be no limit on the number of visits for outpatient MH/SUD care if there is no visit limit for outpatient physical health care.

Prior authorization requirements for behavioral health services must be comparable to or less restrictive than those for physical health serv

If You Want to Learn More about Your Health Insurance Plan

If you have a health insurance plan through work, call your Human Resources (HR) rep for the “summary plan description” and the “summary of benefits and coverage.” You can usually find this number online or on the back of your health insurance card. You may also be able to check your health insurance plan benefits online to see what Behavioral Health Treatment services are covered.

Your Right to Information

Your health insurance plan will provide information to you about all the benefits it offers. You have the right to request this information from your health insurance plan. This includes criteria the plan uses to decide if a service or treatment is medically necessary. If your plan denies payment for MH/SUD services, your plan must give you a written explanation of the reason for the denial and must provide more information upon request.

Your Right to Appeal a Claim

If your health plan denies a claim, you have the right to appeal the denied claim. This means you can ask your health plan to look again at its decision, and perhaps reverse the decision and pay the claim. Call your health plan to ask how to submit a request to appeal a claim.

Parity Resources

For more about the Federal parity law, go to the Department of Labor (DOL) Mental Health Parity page

or call toll-free at 1-866-444-3272 to speak to a DOL benefits advisor.

For assistance with parity issues in Massachusetts, please contact either the Massachusetts Division of Insurance at 1-877-563-4467, MassHealth at 1-800-841-2900, or the BSAS Helpline at https://helplinema.org/ or call at 1-800-327-5050 depending on your coverage.

For additional resources go to Substance Abuse and Mental Health Services Administration (SAMHSA) page and the Centers for Medicare & Medicaid Services (CMS) page.

 

 

 

 

 

 

 

 

 Consumer Guide

How to access Behavioral Health Treatment through Your Health Insurance Plan

We created this Consumer guide to help you make good choices about getting the care you need for you and your family. On the back of this guide we’ve provided definitions of words that health insurance plans use. These definitions should help you understand this process.

• Know Your Health Insurance Plan
• It is important to know what services your health insurance plan covers. In order to gain more information, please contact your health insurance plan to verify your coverage. Information about your specific health insurance plan’s coverage is listed in your policy or certificate of coverage. In addition, your health insurance carrier should provide a Summary of Benefits and Coverage (SBC) that lists both coverage and cost shares in an easy to read format.

When looking for information about your health insurance plan, here are some important questions you should ask:

• What is the difference between in-network and out-of-network, and why does it matter?
  • In-network providers have agreed to a rate with your health insurance plan which will not exceed the cost of your copay, deductible, or coinsurance amounts.
  • Out-of-network providers have not agreed on a rate with the health insurance plan. This type of provider can bill you for an amount beyond what your health insurance plan pays.
• Does your health insurance plan cover out-of-network providers?
• What are the copays if you use an out-of-network provider?
• What services require prior authorization under your health insurance plan?
  • Prior authorization is when the health insurance plan requires you and your Primary Care Provider to seek medical necessity approval before receiving services.
• What if there are no in network options that fit your needs in your health insurance plan?
• Seek “Medical Necessity” Approval
• Health insurance carriers approve services they determine are “medically necessary”. Some medical services require prior-authorization, this means that the health insurance plan must approve treatment before the patients receives services. It is important that your Primary Care Provider (PCP) is involved in this process.
• It is important to note that if you are denied service, you have a right to appeal the denial.
• For more information on how to appeal denials you should contact your health insurance plan.

• Determine Your Out-of-Pocket Expenses

 

Before beginning treatment with a provider that is not covered by your plan, it is important to understand all of your out-of-pocket expenses.

• You should call your health insurance plan to be sure that your plan offers the option to use out-of-network providers.
• It is important to remember that you are responsible to pay for any charges that exceed the allowed amount as set by your health insurance plan.

• Make Informed Decisions

 

As a consumer it is important to make sure you have all the facts and Information before you make any choices on behavioral health care.

Important Tips for Consumers

• Start with your primary care physician and ask them to recommend other providers within the plan’s network.

• Research the providers in your area with your health insurer.

• Consider using an in-network provider. It provides the most consumer protection and it costs less for you.

• Have services approved in advance whenever possible. Please make a note of who you spoke to and the date and time of each call.

• Use the glossary on this page to help you understand the terms that are used by your health insurer.

• Remember, if you have any questions, call your health insurance plan.

 

 

Glossary

Coinsurance- Your share of the costs of a covered health care service, which is usually calculated as a percent.

Copay- A fixed amount you pay for a covered health care service, usually when you receive the service.

Cost Sharing- The amount you pay for health care expenses that are not covered by your health insurer including copayments, deductibles, coinsurance, and provider charges over the allowed amount.

Deductible- A set amount you have to pay every year toward your medical bills.  If you have a deductible, some health insurance plans may not start paying your medical bills until you have met your deductible.

Health Insurance Plan– An insurance company that provides health insurance coverage that pays for medical, surgical and behavioral health expenses incurred by the insured or member. The Health Insurance Plan may reimburse the insured or member for expenses incurred from illness or injury, or pay the Provider of care directly.

Medical Necessity- Health care services or supplies needed to prevent, diagnose or treat an illness, injury, condition, disease or its symptoms and that meet accepted standards of medicine.

Prior-Authorization- A decision by your health insurer that a health care service is medically necessary, this means that the health insurance plan must approve treatment before the patients receives services. This is sometimes called prior authorization, prior approval or precertification.

Provider- A physician licensed to practice medicine in all its branches, licensed clinical psychologist, licensed clinical social worker, licensed clinical professional counselor, licensed marriage and family therapist, licensed speech language pathologist, or other licensed or certified professional.

 

• In-Network Provider- The facilities, health care practitioners and suppliers your health insurer has contracted with to provide health care services to you at a discounted price.
• Out-of-Network Provider- The facilities, health care practitioners and suppliers who do not have a contract with your health insurer to provide services to you. You will pay more to see an out-of-network provider.
• Primary Care Provider (PCP) – A physician, nurse practitioner, or physician’s assistant who is the first line of care for a patient. The PCP will help you get the services you need.

Type of Insurance	Phone Number	Website	By Mail
	1-800-841-2900	www.mass.gov/masshealth	TBD
	1-877-623-6765	https://www.mahealthconnector.org/ombudsman-contact-form	Health Connector Ombudsman Office PO Box 960484 Boston, MA 02109-9997
All others	Division of Insurance   (617) 521-7794	http://www.mass.gov/ocabr/docs/doi/consumer/css-complaint-form.pdf	Office of Consumer Affairs and Regulations 1000 Washington St , Ste. 810 Boston, MA 02118-6200