Today’s Jam

An old friend of mine recently came to visit me in New York for the weekend from his home in Chicago. We had a very nice time together, although I found that he was much moodier than our last visit two years ago. When he left, I noticed that all of the remaining pills (8 or 9) were missing from a bottle of painkillers I was prescribed a few months ago for a sports-related injury. My friend has been suffering from chronic migraines the last few years and I fear that he may also have a problem with narcotics. When he called to let me know that he had arrived home safely, I mustered up the courage to ask him (trying to sound as casual as possible) if he had taken a pill or two for a migraine while he was staying with me. He quickly said no, thanked me for my hospitality, and said goodbye. I am really concerned about my friend, but am not sure what to do. Should I raise the issue with him again in a couple of weeks, or perhaps contact his sister, with whom I am also close?

Rabbi Joshua Stanton says…

Josh Stanton-COLOR

I am by no means an expert in issues related to addiction. Nor are most people. I sense that we should be keenly aware of our own lack of knowledge related to addiction when trying to figure out how to help a friend who might be suffering from it.

A first step would be to contact a professional who specializes in identifying and treating addiction, in order to avoid making presumptions about potential warning signs and ways of responding to them. Engaging a professional is a sign of profound caring for one’s friend. Doing so might be seen as a proactive step in ensuring that any conversation one has with a friend about addiction is done with the utmost care.

My underlying concern is that, though well-meaning, confronting a friend (or more intensively still, conferring with a friend’s sister) without a deeper understanding of addiction could do more harm than good. Unfortunately, so too could inaction.

If a person is indeed suffering from addiction, having friends and loved ones to turn to could be of great help. Yet it is the responsibility of the friend to ensure that they are neither enabling a habit, nor acting in a way that could be alienating to a friend who needs their support and may need it even more if they pursue treatment.

While our own observations could be imprecise, a professional could help us discern veritable warning signs and also come up with a more careful plan of action, which takes into account potential pitfalls we might not even be aware of if acting on our own.

Rabbi Joshua Stanton is Assistant Rabbi at Temple B’nai Jeshurun in Short Hills, New Jersey. He was ordained in May 2013 by the Hebrew Union College-Jewish Institute of Religion, where he also received his Masters in Hebrew Literature in 2012 and studied as a Schusterman Rabbinical FellowPreviously, Josh served as Associate Director of the Center for Global Judaism at Hebrew College and Director of Communications for the Coexist Foundation. He was a Founding co-Editor of the Journal of Inter-Religious Dialogue, as well as O.N. Scripture — The Torah, a weekly online Torah commentary featured on the Huffington Post.

Rabbi Naamah Kelman says…

Kelman-140

This is more than a possible addiction story. This is about trust and honesty in friendship. This is a case where we know that our friend has “stolen” from our medicine cabinet and lied about it.

These two actions are often clear indicators of addiction, as the addict in-denial refuses to own up to other self-destructive behaviors. In other words, there is enough evidence here that something is terribly wrong. Maybe it is because I am a mother, and now a grandmother, that I would indeed react, and react with some assertiveness. One does not have be an expert in addiction to know that this friend is in danger and it is therefore incumbent upon us not to take his “no” for an answer. While our intervention may not work, the words must be said out loud and with love.

“My dearest friend, you are not yourself, you are suffering from pain and confusion, let me or someone else help you! Whether you can admit it or not, those pills went missing. We have years of trust and honesty between us and I must be honest with you even if you are unable to be honest with me!”

Inaction or non-action is a response, and this is an emergency situation in the making. This may risk the friendship, but it is better to err on the side of care and intervention. Better to know that even if he slams the door, we have opened a window that one day he may be willing to reach through.

Naamah Kelman is Dean of Hebrew Union College in Jerusalem. She was born and raised in New York City and has lived in Israel since 1976 where she is involved in progressive Jewish causes including Interfaith work. She was the first woman to become a rabbi in Israel in 1992 and has fought for equality and justice for all Israelis.

Dr. Benjamin Linas says…

Benjamin Linas140

This is a challenging situation, and unfortunately one that many people face every day. Your friend most likely has a prescription opiate addiction, as Josh and Naamah noted. He is not alone. Approximately 12 million people in the U.S. report using prescription painkillers for non-medical reasons, and prescription opiate overdoses have more than tripled since 1990.

My main advice in addressing the issue with your friend is to remember two underlying principles: offer your friend help in the same way you would if he were suffering from any serious diagnosis, (e.g. cancer), and remember that the goal is to help your friend, NOT yourself.

With these basic principles in mind, I would take the following steps:

  1. Speak to your friend, openly and honestly, and express your concern about his addiction and your desire to help. It is crucial that you be non-judgmental and very clear that you are worried – not angry, disappointed, or disgusted.
  2. Explore your friend’s support structure. Who else knows about his addiction? In many cases, parents are a natural support, but not always. If his parents are not a good option, then who else is?
  3. Going forward, I would make it clear to your friend that he is, and will always be welcome in your home and with your family. However, no one should have old prescriptions for potentially life threatening medications “lying around” the house. What if your toddler found them? What if your toddler’s play date found them? This could be a catastrophe.

Unfortunately, there is a very high probability that your friend will deny any problem and potentially be angry with you for suggesting that he has an addiction. In that case, I would remind him that you are coming out of concern for his health and happiness and that if he is ready to discuss further, you will always be available.

Finally, even if your friend acknowledges his addiction, he may not be ready to take action to address it. If so, then I highly recommend that you adopt a “harm reduction” approach to working with his drug use. Thus, even if he continues to use prescription pain medications, you will be helping him if you can reduce the chance that he is harmed by opiates during the time that he is using them. When you have established yourself as a friend who “gets it,” you will be in a MUCH better position to really help him stop using drugs.

Dr. Benjamin Linas is a physician scientist dedicated to improving the health of vulnerable persons living with HIV and HCV infections. His research investigates the comparative- and cost-effectiveness of interventions to identify and treat HIV and HCV, employing methods of computational biology and clinical epidemiology. 

Now, what do YOU say?

Have you ever had to confront a friend about their dangerous behavior, not knowing how to approach the situation? Would you defer to a professional, or trust the strength of your friendship to guide you as you sought the best for your friend? We welcome your thoughts in the comments section below.

And of course, if you have a dilemma you’d like us to address in the Ethical Jam, send it to EthicalJam@timesofisrael.com

Ethical Jam is a project of the Center for Global Judaism of Hebrew College, Newton Centre, Massachusetts, which is working to create a rich pluralistic discourse on issues of vital concern to the Jewish community and to the world at large.

HC_Logo_CGJ_RGB smaller

The opinions, facts and any media content here are presented solely by the author, and The Times of Israel assumes no responsibility for them. In case of abuse, report this post.