Episode 153 - Substance Abuse in Child Custody Cases with Dr. Kim Oppenheimer

One of the things we notice during the holidays is an increase in cases involving some form of substance abuse, especially alcohol addiction. The combination of being at home from work, easy access to alcohol, high tensions at home, and all the social events can have disastrous consequences for a family where one parent is struggling with addiction. In this show, we interview Dr. Oppenheimer to talk about the impact of substance abuse on children. She also explains the in-depth testing that she performs as part of her custody evaluations to identify whether someone is suffering from a substance use disorder. We wrap up the show discussing the ways that Dr. Oppenheimer helps lawyers and clients craft parenting plans that provide safety for the children while still giving some visitation to the parent dealing with a substance abuse. During the show, we touch on a video that gives a remarkably scary visualization of what children see when their parent is suffering from some form of addiction.

Leh Meriwether: Welcome everyone. I'm Leh Meriwether and with me is Todd Orston. Todd and I are partners at the law firm of Meriwether and Tharp and you're listening to Meriwether and Tharp Radio. Here you'll learn about divorce, family law, tips on how to save your marriage if it's in the middle of a crisis, and from time to time even tips on how to take your marriage to the next level. If you want to read more about us, you can always check us out online at atlantadivorceteam.com.

Todd Orston: Well done.

Leh Meriwether: Thank you. You know, years ago I went to write an article in, I think it was the Cherokee Tribune. It was like 2012, and it was about this time of year and I'd heard all these things on TV about how the suicide rate is up during this time and I'm like, well, maybe that's what I'll write an article about. So I started doing research and turns out those articles weren't right. That the suicide rate actually doesn't go up during this time. But what did go up was incidents of family violence during this time because you had couples that were together during the holidays, there was time off. And one of the big factors often was alcohol. So I was doing all this research and all this stuff started and I was like, wow. I'm glad I did some research before I wrote something. That's what we're supposed to do anyways.

Todd Orston: Well, you and I have both been doing this a long time and I can't even count at this point in my career how many cases, especially during holidays, where there are issues relating to what I'm going to refer to as substance abuse, whether it's drugs or alcohol. And that of course has a direct impact on the behavior of parties in a relationship and all of that sort of bubbles up to the surface and becomes a real, real issue that we have to then deal with and sometimes litigate in the context of a divorce or other kind of custody case.

Leh Meriwether: So, several weeks ago I got an idea to reach out to someone who's an expert in this area, since we are not.

Todd Orston: Okay, fine. You are a special little ... I'm proud of you. Great idea.

Leh Meriwether: Oh gosh.

Todd Orston: It's already starting. So what was your idea Leh?

Leh Meriwether: I invited Dr. Kim Oppenheimer on the show.

Todd Orston: Great idea. We should definitely invite her.

Leh Meriwether: Well, she's here.

Todd Orston: You know, it's a big studio.

Dr. Oppenheimer: Hi Todd.

Todd Orston: Weird. Strange I didn't see you sitting there for the last hour.

Leh Meriwether: Let me take a moment to introduce our guest Dr. Oppenheimer. She's a clinical psychologist who specializes in performing forensic, psychological, and custody evaluations. She performs these evaluations through her company Child Custody Solutions, LLC. In addition, she is the founder and owner of Atlanta Psych Consultants, LLC, a multi disciplinary private practice located Sandy Springs. In her psychotherapy practice, Dr. Oppenheimer treats individual adults, couples, and families. Her specialty areas include psychotherapy, marital therapy, reunification, reconciliation, family therapy, co-parenting, parent coordination, and divorce adjustment.

Dr. Oppenheimer has published numerous research articles in professional journals and has many peer reviewed presentations in the areas of divorce adjustment and anxiety disorders. Prior to her full-time private practice Dr. Oppenheimer ... Sorry. I'm terrible with names.

Todd Orston: Listen, no, you're doing well. Okay.

Leh Meriwether: Was an associate professor of psychology at Georgia State University where she taught graduate classes in psychological testing and psychotherapy. I could go on and on about Dr. Oppenheimer and create more opportunities for Todd to make fun of me, but that would take up precious air time. You can read more about her and her private practice at atlantapsychconsultants.com

Dr. Oppenheimer: Thank you Leh.

Leh Meriwether: Thanks so much for coming on.

Dr. Oppenheimer: Oh, my pleasure.

Leh Meriwether: Actually several lawyers in our firm have used you over the years. I hadn't had the pleasure until they introduced me to you. And I am so happy that you agreed to come on to one of our seminars that we did this year.

Dr. Oppenheimer: It was in March.

Leh Meriwether: My gosh, everything's running together. This year. And you came on to really explain issues surrounding substance abuse. And alcoholism, that was one of the focuses of that day, but the material you have goes a little bit beyond just alcohol but that's one of the ones we seem to run into most frequently. And the information was so compelling I was just like, we got to have you on the show. And I'm glad you agreed to come.

Dr. Oppenheimer: That's very kind. Thank you.

Leh Meriwether: So let's start off. I'm not kidding, I have had several calls just in the last few weeks just dealing with this issue. It's so unfortunate. One of the surprising things from the seminar you did with us was a statistic that you had on the screen was ... What you had up there was, depending on the study almost a third of adults in the US meet the criteria for alcohol use disorder at some point in their lives, about 20% of whom are treated. That was astonishing to me.

Dr. Oppenheimer: That is absolutely correct. And as you mentioned before, this time of year is particularly problematic. Everybody's celebrating and people who have problems with substances have more difficulty controlling it. Because really substance use, substance abuse is on a continuum. There are people that don't drink at all. And one of the questions when I interview somebody who does not drink, I ask why. Because it is so common in not only our culture, but other cultures. And a lot of times it is because they have a problem and they've been to AA or they've been to rehab and they're taking their abstinence very seriously. And in that continuum you've got the social recreational drinker, then you've got the person who it's a habit. You know, get home from work every day at 5:00, has a cocktail or two. And then to abuse, where they drink more than is intended, to actual addiction, which is some physiologic process that involves tolerance and withdrawal.

Leh Meriwether: We're going to get into all that today because when you've got parents that are one of the parents, or sometimes both the parents, have an issue regarding the use of alcohol or some other drug or mood altering substance, it can really impact the children. So what are some of the signs that someone might have a substance abuse problem?

Dr. Oppenheimer: Well part of it depends on the substance, but of course there are physical signs. For example, someone that has a cocaine addiction or they've been using cocaine, maybe not necessarily an addiction, they have what's called cocaine eyes. Their pupils become very dilated even in a bright light. Their nose may be red and runny. Someone who is smoking marijuana has that telltale smell. One of the things that we look for is any type of behavior or personality change. So for example somebody may become angry or erratic or they may become quiet and withdrawn. And for the purposes of child custody evaluations we look for changes in role responsibilities, or not being able to fulfill them. This is particularly true when it comes to parenting responsibilities. They're passed out on the couch or they're not showing up at performances or school functions, or they're missing picking the children up from school or taking them to school, or they're chronically late because of hangovers, unable to get out of bed. So the failure to perform role responsibilities is very important in looking at how people are parenting their children.

Todd Orston: How do most people come to you? In other words, somebody, to really get help they need to want help right? So in other words, all this information that you're looking for about behavioral changes and things like that, are you getting that from the person seeking the help or are you getting that from third parties who are providing you information about how behavior has changed due to certain behavior?

Dr. Oppenheimer: Great question. Well, in my role I'm doing forensic alcohol and drug evaluations most typically in the context of a custody evaluation. So I may be the custody evaluator, in which case I'm court appointed, and an alcohol drug evaluation is included in my order. And those referrals either come directly from the court or from attorneys such as yourselves. Or from a guardian ad litem. The alcohol and drug evaluation itself, anyone who is only accepting the report of the individual, it's probably not a very thorough evaluation. Because as we get into substance abuse, substance addiction people typically hide the amount that they're using, the frequency that they're using and so they are not credible self reporters. So for that reason we look at collateral sources of information, whether that is driving records, bank records, financial statements, their spouse, sometimes their children if they're old enough. But kids see and hear everything and talk about what is happening at home. Unfiltered, unlike their parents usually.

Leh Meriwether: Wow. I just realized, yeah, I've had cases where the kids were ... They were cold. They were much harsher than the other parent.

Todd Orston: The filter is they don't know what to say, what not to say. They're just trying to tell the truth about what they're observing and experiencing.

Dr. Oppenheimer: Right. And so for example they'll talk about mom or dad. They went to take a sip of the coke and it didn't taste like coke. It tasted really bad. And so that's an opening to-

Leh Meriwether: And up next we're going to continue to talk about this as well as a really frightening movie we saw on the subject.

I just wanted to let you know that if you ever wanted to listen to this show live, you can listen at 1 a.m. on Monday mornings on WSB. So you can always check us out there as well.

Todd Orston: Better than counting sheep I guess. Right?

Leh Meriwether: That's right.

Todd Orston: You can turn on the show and we'll help you fall asleep.

Leh Meriwether: There you go.

Todd Orston: I'll talk very soft.

Leh Meriwether: Welcome back everyone. I'm Leh Meriwether and with me is Todd Orston. Todd and I are partners at the law firm of Meriwether and Tharp and you're listening to Meriwether and Tharp Radio. If you want to read more about us, you can always check us out online at atlantadivorceteam.com.

Well today we're talking about a very difficult subject. We're talking about substance abuse. Most of the time it's some form of alcohol abuse, but it can also be drugs and even prescription medication. But knowing that we're not the experts on this subject, we brought with us Dr. Kim Oppenheimer who's a clinical psychologist who focuses on dealing with child custody cases. But usually I know the lawyers that have used you in the past, there was an alcohol component and so they told me originally, especially when I was putting together the seminar this year ... I was putting it together last year for this year. "We have to have Dr. Oppenheimer." Because you really do thorough investigations into allegations of some form of substance abuse.

So let's talk real quick about how this impacts ... What sort of parenting challenges are caused by substance abuse?

Dr. Oppenheimer: Well one of the things that's really important for children is structure and consistency. So when you have a parent that is abusing or addicted to a substance, their ability to provide that stability, the routine, the structure that children need to thrive is absent. Because typically people with a substance abuse problem are unpredictable. And if there is one person that is abusing, typically the spouse is not happy about that, leads to parental conflict, stress, a lot of fighting, a lot of parental absence from the parent who is abusing the substance.

Leh Meriwether: So what are the psychological impacts on children of parents who have substance abuse or addictions?

Dr. Oppenheimer: Well, they can fall into several different categories, but on the one hand they can become anxious, fearful. Children of alcoholics typically are very vigilant. They are hyper focused on the behavior of the parent because that parent could become angry at any minute. Oftentimes they report tiptoeing around their parent because they don't know what's going to set him or her off. The other side is that they often become the little adult in the family. So they take on responsibilities for younger siblings or sometimes even household chores. Especially if both parents have problems with substance abuse, the oldest child in the family often becomes the parent.

Todd Orston: Have you ever seen children take on a caretaker role? Meaning they feel like they need to take care of the person, the parent, with that problem.

Dr. Oppenheimer: Oh absolutely. I can recall several cases where the children were the ones going to the grocery store. Even if they were walking. So that they could provide food. They would come home, cook. They did the laundry. They wrote checks out. They would call an Uber to go pick up mom or dad at the bar. Absolutely.

Todd Orston: Yeah, I had a case once where the children basically were helping the parent when that parent was incredibly intoxicated, getting them from passed out on the sofa into their bed, cleaning them up when they needed to be cleaned. Things that no child should ever have to see or experience. They were thrust into this very adult, unfortunate role in the family, but they felt they had to do it.

Leh Meriwether: When you did your presentation to us you played this video. And I actually found it on YouTube. It was called Fragile Childhood - Monsters. And it gave Todd and I, both of us, nightmares. It was terrifying. Those child actors that they had ... Definitely go watch. It's a minute. But it is a very powerful minute.

Dr. Oppenheimer: It's powerful.

Leh Meriwether: And I don't know what kind of impact it might have on a parent, like to play it for them, but I mean-

Todd Orston: Yeah. It's not like the old, this is your brain on drugs commercials. This really hit it from an angle where it was scary, absolutely, but it was very eye opening. It really made you think about the problem from a different angle.

Leh Meriwether: From the child's perspective.

Dr. Oppenheimer: Right. Through the lens of a child, in terms of what they see in their parent who's abusing substances. They take on a different, almost, persona through the child's eyes. They do. The child is so tuned in and afraid of what that parent might do that the parent does seem like a monster. And it's all surrounded with the unpredictability of how that parent may behave.

Leh Meriwether: Yeah. And one of those kids I do remember, he was walking on a basketball court or something and he was just staring at his father who had this scary look. I mean, you got to see the video. But unfortunately Todd and I both have cases like this and I have seen a parent show a video where I've seen that look from that boy, how he was looking at his parent from the sidelines. It's so ...

Todd Orston: Well that goes into the first thing you were talking about, about denial. Where the person with the problem is in denial, not only about their own problem, but the impact that their problem is having on everyone around them including the kids. And you get to speak with children. You get to see and hear from them. And in a more limited way we get to sometimes hear from the kids, but the impact is incredibly bad. It's a powerful impact on these children who don't know how to act and don't know why it's happening and what they can do to fix it. And it's devastating.

Dr. Oppenheimer: Well it's also a lifelong impact because when children see their parents as their parents do not see themselves. As these unpredictable figures who can't provide structure and routine for them. It becomes overwhelming for them. Very frightening. And if the substance abuse dis-inhibits their behavior and they become angry, particularly violent, I've heard children talk about hiding in the cupboards or hiding under the beds. They don't typically get over that. I mean, this is a lifelong impact.

Leh Meriwether: Let's start talking about who identifies some of the symptoms. Because I do know that there is a criteria for it. There's a manual out there. It's called the DSM-

Dr. Oppenheimer: Yeah, DSM-5.

Leh Meriwether: The DSM-5. And it is something that's put out by a group of psychologists right?

Dr. Oppenheimer: It's the American Psychiatric Association.

Leh Meriwether: Okay, thank you. That's why she's here.

Dr. Oppenheimer: This is the bible. This is our diagnostic manual used by psychologists and psychiatrists in terms of diagnosing someone. And in terms of substance abuse, it's called substance use disorder.

Leh Meriwether: That's the technical term?

Dr. Oppenheimer: Correct.

Leh Meriwether: Okay.

Dr. Oppenheimer: And there are a lot of criteria, 10 or so, in terms of identifying someone that meets our diagnostic criteria for substance use disorder.

Todd Orston: And most lay people, oftentimes they will categorize as oh that person has a substance abuse problem. But my understanding is substance abuse, the term abuse, actually is just a category in the substance use disorder. I'm trying to, like lay people who don't do what you do, if they're trying to define it substance abuse is something that falls under that umbrella of substance use disorder?

Dr. Oppenheimer: Yes. Substance abuse, again, as I mentioned a little while ago, is on a continuum. So if you think about five points, and we could probably identify more, but the addiction, the substance use disorder, tolerance and withdrawal certainly is a piece of that. Substance abuse refers to taking more time to obtain the substance. There is a focus on obtaining the substance. There can be cravings and more is ingested than intended.

Todd Orston: What about the hiding, like the people who ... Not just how they get it, but they are then hiding it and there are stashes and there are ... Like there's a lot of behavior surrounding the consumption.

Dr. Oppenheimer: Yes. That is not a recreational user.

Leh Meriwether: I think it actually might be helpful, even though it kind of gets technical, I wouldn't mind going through the DSM criteria. There's 10 of them right? There's 10 criteria that you look at.

Dr. Oppenheimer: Yes.

Leh Meriwether: And the reason I kind of want to go through this is because perhaps you may be listening to this or someone has shared this message with you, maybe you're listening to it when it's not live. Because we may be able to stop someone from getting to that bad place. Maybe they started a habit of drinking every night. They came home and it's moved into the category of abuse. Maybe it hasn't moved into addiction yet. Because if you can better understand what's going on, maybe you can get help before you develop that physiological addiction to whatever substance you're using. Can we do that when we come back?

Dr. Oppenheimer: Absolutely.

Leh Meriwether: All right, so when we come back we're going to go through the DSM-5, which is the diagnostic manual criteria of the different levels of substance use disorder.

Todd Orston: Hey everyone. You're listening to our podcast, but you have alternatives. You have choices. You can listen to us live also at 1 a.m. on Monday morning on WSB.

Leh Meriwether: If you're enjoying the show, we would love it if you could go rate us in iTunes or wherever you may be listening to it. Give us a five star rating and tell us why you like the show.

Welcome back. This is Leh and Todd and we are in studio with Dr. Oppenheimer on Meriwether and Tharp Radio. If you want to listen to the previous segments, we're talking all about substance abuse and substance use disorder. If you missed the first two segments, you can always check us out online at divorceteamradio.com. But we have so much information to get to. I want to jump right back into it. We talked off air real quick that going through all 10 aspects of the DSM-5, all that criteria, we'd run out of time. And I do want you to share how you go through your analysis when you're evaluating someone. Because there's oftentimes that people feel like, oh they can get away with it, they can fool the tests. So I don't want to eat up all the hour, the rest of our time together, with that. So let's talk in generalities, when something moves past sort of habit and into abuse and addiction.

When we were off air you were giving an excellent description of that and I should have been recording when you were talking about that. So let's go back to that.

Dr. Oppenheimer: Okay. When I'm assessing someone whether they have an addiction problem according to the DSM, we go through each different type of substance. So for example, alcohol. Go through and see how they meet criteria. Same thing for marijuana or stimulants or opiates, and so on. But basically in terms of the addiction, I'm looking for the three Cs. One is craving or compulsion. And this is, to a large extent, physiologic, although there is a psychological component to it. And that is trying to obtain the substance, spending a lot of time focused on it, thinking about it, time trying to acquire it, a physiologic craving. Certainly with some substances you have withdrawal. Alcohol being one, opiates being another. And just as an aside, the effect of the substance, whether it is to be stimulating or relaxing, the withdrawal is the opposite of its intended effect.

So with alcohol, which is a depressant, people typically become very agitated on it. With cocaine or the other stimulants, people become lethargic, depressed, they want to stay in bed. The withdrawal effect. So that has the impact on the person because it's not the effect that they want. And chronic use of these substances does rewire the brain. It particularly affects the dopamine system, the reward system, the pleasure center in our brains. And so that feeds into that craving and compulsion because we're trying to get that reward circuitry back stimulated. And of course over time what happens is that it absolutely burns out. And by that point somebody is in really severe trouble.

Leh Meriwether: It burns out the reward part. Because you develop a tolerance to it.

Dr. Oppenheimer: Absolutely. Yes.

Leh Meriwether: So you need more and more each time, whether it's alcohol or cocaine, you just need a bigger hit every time.

Dr. Oppenheimer: Yes.

Todd Orston: And then it just becomes an issue of maintenance and just an issue of ... You're not even chasing the high anymore. At that point you may have created a situation where you need it.

Dr. Oppenheimer: Excellent point. Absolutely. And sometimes because the substance, it's impact wears off, people develop what's called a process addiction. They may then get into gambling or pornography or sex or something like that.

Todd Orston: Trading one for another.

Dr. Oppenheimer: Yes.

Todd Orston: Okay.

Dr. Oppenheimer: Yes. And another thing that I look for is continued use despite negative consequences. That could be someone who's lost their job, they've lost their marriage, they've lost their family, they've lost substantial income in trying to obtain this substance. And then the other is loss of behavioral or emotional control. People who become angry or violent. Have they had complete changes in their personality or how they appear to other people. They can't maintain kind of whatever public persona that they have had.

Leh Meriwether: When you did your presentation you had a lot of material that there's not enough time on this radio show to go into. But one of the things you talked about, there's that 10 criteria from the DSM-5 and you had sort of a sort of sliding scale. It said if there were two to three symptoms present it's a mild substance use disorder, four to five symptoms present, moderate, and then six or more, severe. So let's say there's a concern about one of their spouses. And maybe this spouse is ... Maybe they've had a rough year at work or maybe they've lost some family members and they've turned to alcohol to help with that. So someone's concerned. There's a few things going on there. Is it a good idea to have them come in and see you for an evaluation so they could say, "You kind of do have a mild substance use disorder. We need to work on you avoiding ... What you're doing right now may just be a habit, but we don't want to make it turn into that addiction."

Dr. Oppenheimer: And that's a good point. And certainly going in to see a mental health professional would be helpful because people do self medicate. During times of stress it's not uncommon for people to drink more. And as you say Leh, that can become a progressive disorder. So it's important. Sometimes the substance use disorder is primary, sometimes it is secondary to depression or anxiety and the substance is being used to self medicate. I mean basically it's a coping mechanism. And one that can be problematic. So helping figure out the role that it is playing in the person's life is extremely important to prevent it from becoming more of a progressive illness. And that's particularly true if someone has a family history of substance use disorder. A parent or grandparent had problems with alcoholism because they have the genetic predisposition for addiction.

Leh Meriwether: I'm glad you mentioned that about the fact that there's ... What are they called? Co-occurring-

Dr. Oppenheimer: Psychopathology.

Leh Meriwether: Yeah.

Todd Orston: Oh you were going to struggle with that.

Leh Meriwether: But I did have a case where the case started off where it appeared that one of the parties was an alcoholic, but it turned out they were suffering from undiagnosed clinical depression. And they used the alcohol to treat it. And then once it was determined that there depression then we got a really good psychiatrist involved, got them on the right medicine, and the alcoholism ... I mean there was a little withdrawal issue, but once that withdrawal issue went away the cravings were gone. Because the cravings were in part created by the clinical depression.

Todd Orston: Well yeah, I've had those cases too where the addiction is the problem. And I've had the cases where the addiction is just a symptom of something much deeper.

Dr. Oppenheimer: An overuse solution.

Todd Orston: Yeah. Right.

Leh Meriwether: Yeah. I mean, I think that's good for people to know because they hear that alcoholics or addicts, it's hard for them to overcome it, but there are some out there that it's sort of easy if that is the symptom of the underlying problem.

Dr. Oppenheimer: Correct.

Leh Meriwether: I think the biggest challenge obviously is getting the person that is suffering from it to be willing to be open to getting help. I know you're usually in the evaluation stage, but ... And if you don't, I don't want to put you on the spot. Do you have any recommendations for a parent that's trying to convince another parent that they're concerned or maybe an issue like to get them in for an evaluation?

Dr. Oppenheimer: Well they can offer to come in. Let's go in together and talk about what's happening and kind of talk about what's happening in our family as a way of improving it. And sometimes that opens up the possibility of really exploring the role that alcohol is playing in the family.

Todd Orston: As sort of a follow up to that my question would be what about the person that does not have the substance use disorder issue going in seeking help themselves to try and give them the tools to communicate better with their spouse to try and convince them? I've had some clients where they actually went voluntarily to Al-Anon to learn about whatever the disorder might be, whatever the issue might be just so they could better understand what the problem is and what they can do to try and help fix. So is that a good thing to do to try and go and seek some help yourself so you can better communicate?

Dr. Oppenheimer: Well, yes and no. Absolutely getting help for yourself is important because it's difficult living with someone. As we talked earlier, it has an impact throughout the family. And people who are living with someone who's abusing substances often becomes angry and depressed themselves. But they have to give up the notion that they're going to be able to fix this person or fix this problem. So Al-Anon is very helpful, but also just acceptance. This person who is abusing has choices and they may continue to choose to abuse. And you may continue to live in this marriage or you may choose to leave.

Leh Meriwether: That's a good point. Just remember that it's their choice, not yours, and you can't change. They have to make that change. Because people can really get really beat up. They beat themselves up because I can't change them, I can't fix it, but it's not up to them.

Dr. Oppenheimer: Right. And then they become codependent and it becomes an even more difficult system for the children.

Leh Meriwether: So up next we're going to talk about your testing and then the recommendations that you often make for parenting plans when we have a case of substance abuse disorder.

I just wanted to let you know that if you ever wanted to listen to this show live, you can listen at 1 a.m. on Monday mornings on WSB. So you can always check us out there as well.

Todd Orston: Better than counting sheep I guess. Right? You can turn on the show and we'll help you fall asleep.

Leh Meriwether: There you go.

Todd Orston: I'll talk very soft.

Leh Meriwether: Welcome back everyone. This is Leh and Todd and we're in studio with Dr. Oppenheimer. And we have been talking about substance use disorder. That's the technical term for substance abuse or things like alcohol addiction and everything. Because it actually is identified in what's called the DSM-5. And we've been talking about the impact it has on families, the impact it has on children, and how to identify it, what sort of factors come into play when someone has reached the level of a physiological addiction. And now we're getting into some of the legal components. We're going to spend the last segment, because most of the people listening to this are dealing with someone that is suffering from this and they've just made the decision to go through the divorce or something along those lines or there's an issue surrounding custody and one parent has a substance abuse issue.

So I wanted to go through the testing you do in general nature and then what sort of questions can you help the clients and the lawyers answer when preparing a parenting plan to make sure the children are safe when there's someone suffering from an addiction. So let's start with someone's come to you, there's an allegation of a substance abuse, alcohol addiction, that sort of thing, the other person is flat out denying it, what steps do you go through to find out whether the allegation is true or not?

Dr. Oppenheimer: What I want to know is basically what is the role of the substance in this person's life and what is the impact on functioning? So when I have somebody in my office, typically the first interview is kind of just tell me about this and I ask questions about what's happening now, what's happening in the family, what happens when they drink. I get very detailed information. Such as where do you drink? In what situations? Well, I only drink in front of the TV watching football. Well how many hours do you spend watching football? Well on Saturdays there are games from basically 12 to 12. So what happens then? Oh, I have a beer. Okay, how often and how many? And we get very detailed about that. Typically someone who is abusing substances, as I mentioned before, is not completely forthright. So for that reason I have multiple interviews. I also will ask for interviews with the spouse and anybody else that may have information about that.

Depending on the age of the child or children I might talk to them. Particularly if they are older teens or young adults, I might have them come in. But I can talk to neighbors or coworkers. Anyone who would happen to have witnessed the consumption of, say alcohol. I also am going to do some psych testing and that gives me information in a different way. And there are ways in those tests that I can determine whether somebody is shading the truth or presenting themselves more favorably perhaps than the circumstances warrant. I'm also going to order alcohol and drug testing. So I will send them for a urine screen, I'll send them for a blood test. And in some situations maybe even hair follicle test. It depends on basically how recently. And you can think as a rule three, three, three. So an alcohol test will pick up about three days, a blood test will pick up about three weeks, and a hair follicle test about three months.

No, that is not exact. It depends on how a person metabolizes. But if I have someone who says, "No. She's exaggerating. I don't stay in front of the TV all day and drink beer or whatever." I'll say, "Okay. Let me go have you take a urine test or a blood test." And those are very reliable. And they're cutoff scores so I can see how much they're drinking.

Todd Orston: And very quickly, I want to make sure it's very clear, all these things that you are asking that person to do, that's within the authority granted to you by the court.

Dr. Oppenheimer: Correct.

Todd Orston: So I want to make it very clear, this is not you're coming up with ideas and they can say no. At the end of the day the court will say you must comply with these things that are being asked of you.

Dr. Oppenheimer: Absolutely. Which is very different than if somebody's coming into me for psychotherapy. In which case, we don't do any of this.

Todd Orston: Right.

Dr. Oppenheimer: I mean the approach is very different. But I'm talking about under the auspices of a court ordered alcohol and drug evaluation.

Todd Orston: Okay.

Dr. Oppenheimer: I'm also going to ask for bank records. Financial statements, credit card statements. And even though it's not proof positive. As attorneys would argue the opposite depending on what side you're on. But if I'm seeing ... In fact I can recall a case. If I'm seeing routine cash withdrawals at different locations on the same day-

Todd Orston: Or even over numerous days at the same ATM that's right across from a bar that other witnesses say that person goes to all the time. I've had that case as well.

Dr. Oppenheimer: Yes. And I'm going to ask for receipts. I'm going to ask for credit card statements and see is alcohol being purchased. And of course there are some tricky ways of kind of getting around that. But the point is is that we're going to do a multi modal, multi method assessment. What that means is I'm going to talk to different people. I'm going to talk to the person him or herself. I'm going to get records. I can get driving records, insurance premium records. Basically anything. History of DUIs. Motor vehicle records. All of that. Because when it comes to parenting your child the safety of the child is paramount. That is my task as a court appointed evaluator. What is in the best interest of the child or children. So I'm sorry. You're entitled to drink or do whatever you want, but you cannot endanger your children. And so when you've got minor children, that is the number one priority. So I'm going to try and do my best to figure out what is happening to protect the children.

Leh Meriwether: All right, let's switch gears real quick. We only have a few minutes left so I'm going to just leave the floor to you. I know one of the things you help with is crafting a parenting plan that will provide safety and protection for the children and I know you have a lot of questions that you've given us that you try to answer. So if you wouldn't mind just sort of going through all those questions. Here's the questions I try to help clients and lawyers answer after I do my assessment.

Dr. Oppenheimer: Yes. Because the court basically wants to know okay, does this person have a substance abuse problem and is it impacting their parenting? So let's assume the answer is yes. Well, how do we protect the children then? Because the relationship with that parent is still important. In an ideal world we want that parent to get help. So this isn't meant to be punitive. It's really meant to be corrective and rehabilitative. So in order to keep the children safe are we going to require random testing? And the answer almost always is yes. Can this parent drive with the child? Well if there's no history of DUI and the parent comes home from work and drinks at home and never gets behind the wheel of a car, probably not going to recommend some sort of interlock device where they have to breathe into this device in order to start the car.

Let's say they have these drug tests. What happens if one is diluted? Which means that somebody has tried to drink a lot of liquid in order to get the urine screen clear. You know, pass the substance through their system sooner. That will show up. In that case, that's considered a dirty test and so we may have them start again with some kind of graduated parenting plan, supervised time, time that is perhaps during the day, no overnights. So the parenting plan becomes crafted to the problem that the individual is having. Can the parent drink on a limited basis when they don't have the child? Well if it hasn't gotten to the level of addiction, the answer may be yes. As long as you don't have the children you can have a glass of wine or drink. But when you have the children you've got to be completely abstinent.

Somebody who has reached the level of addiction cannot do that. They have to be abstinent.

Todd Orston: And I will tell you, as an attorney I will say, if you are under that kind of scrutiny, do whatever you can not to have that occasional glass of wine. You need to walk away from that behavior because you're under a microscope.

Dr. Oppenheimer: Yes. And you would be surprised though at the number of people who do not do that.

Todd Orston: Oh I have some stories.

Dr. Oppenheimer: And so they come in, they say, "Well, I'm not drinking." And I say, "Okay." I order a urine screen and lo and behold they have been drinking. "Well I didn't do it when I had the kids." Okay, well this does not look good. The court does not like how this appears.

Leh Meriwether: Well, Dr. Oppenheimer, unfortunately we're out of time.

Todd Orston: Thank you very much.

Leh Meriwether: Thanks so much for coming on.

Dr. Oppenheimer: Oh, my pleasure.

Leh Meriwether: I really appreciate it. Real quick, what is your website again in case someone needs to use you?

Dr. Oppenheimer: It's atlantapsychconsultants.com.

Leh Meriwether: Awesome. This is the holiday season. I hope no one out there is having to go through any of this, but there is help if you are and definitely you can reach out to mental health professionals and you contact lawyers and there are things we can do. Thanks so much for listening.