Getting the right help for the individual is essential to successfully treating addiction. Getting help for the family of the individual is also very important, and it is something that shouldn’t be overlooked. Everyone in a family suffers when a member has an addiction to substances. Help is out there, and below are some resources designed to treat the family members of addicts.

Spouses of Addicts

Oftentimes, spouses understand more than anybody about how an addict is suffering. Whether the couple had a healthy relationship before the addiction took over or not, the other adult in the household can see what both the addict and the family are sacrificing because of the addiction.
Al-Anon holds regular meetings throughout the country to encourage families of alcoholics to focus on their own peace of mind and strength. Nar-Anon, like Al-Anon, focuses on the Twelve Steps to healing for family members. Nar-Anon helps families of individuals addicted to narcotics, and it also holds free meetings throughout the country.

Co-Dependents Anonymous is another support group for spouses. Because of the stress that addiction can put on a couple, often the spouse of an addict develops an unhealthy co-dependence in an attempt to hold it all together. Co-Dependents Anonymous helps individuals to free themselves from destructive behavior and if possible live their lives with their spouse, but not dependent on them.

Parents of Addicts

Adolescents addicted to drugs pose a difficult problem. Being so young, it is important that the child and their family get help for the addiction right away so the teen can look forward to a life free from this suffering. Adolescents are usually still living in their parents’ homes and under their rules, so it is especially important for parents to be informed about the methods of treatment and ways to help their child when they are back home.

The Phoenix House is a New England-based coalition of professionals that work together to provide treatment for young addicts as well as counseling for the entire family. Parental involvement is key to these programs and education, activities, and therapy are provided for entire families.

Inspirations for Youth and Family is another organization that treats adolescents for drug and alcohol abuse. Families are also provided with therapy and activities that work toward the goal of reuniting the family.

Children of Addicts

Not to be overlooked, children in a family with addiction also suffer and should receive treatment. The Center on Addiction and the Family (COAF) offers a wide range of programs that help the whole family deal with addiction, some specifically geared toward children. Alateen offers meetings for teens of alcoholics, much like Al-Anon. Even though they might not have a very large voice when it comes to addiction in the family, children are very much in need of counseling or treatment as they suffer with a loved-one’s addiction.

Families have many options to getting treatment as they deal with an addict among them. It is important to reach out for help from professionals in order to free themselves from the addiction.

More Resources
http://www.treatmentsolutionsnetwork.com/families-addiction-treatment.html

drug addiction support groups

• Narcotics Anonymous (N.A.)
• Cocaine Anonymous (C.A.)
• Crystla Meth Anonymous (C.M.A.)
• Marijuana Anonymous (MA)

other addiction support resources

• Find an AA Meeting Near You
• AA Meetings Online
• Gamblers Anonymous (GA)
• Find an MA Meeting Near You
• Find an NA Meeting Near You
• Nicotine Anonymous
• Overeaters Anonymous (OA)

Families of drug or alcohol abusers go through a lot of painful feelings as they struggle with their loved ones’ addiction. Sometimes these family members are overlooked as help is being offered to the person with the drug or alcohol problem. New initiatives have been formed in recent years that focus on a family approach to addiction treatment, and it has proven to be a benefit to not only the addict, but also to his or her family as well. Support groups have also been organized that help family and friends deal with those with addictions.

Support for Spouses of Addicts

It has been said that alcoholism is a family disease, affecting the entire family. Perhaps spouses are the first to notice a problem with addiction, and their lives may change the most. A once-loving spouse and parent to their kids becomes withdrawn, depressed, unreliable, and hard to spend time with. It is very painful to watch someone you love wreck themselves over substances.

Support for Parents of Addicts

Parents go through much pain also as they watch a child struggle with addiction. Feelings of helplessness, failure, and embarrassment are common in these situations, and often parents question where they went wrong and don’t know how to fix it.

Support for Children of Addicts

Children, however, may often suffer the most. To not have the parent around to care for them properly or to spend time with them takes its toll on children. Abuse and neglect commonly go along with parents that do drugs or are alcoholics, and these kids suffer greatly. It is common for these kids to go on to abuse substances themselves one day.

Al-Anon

Because addiction has such a strong effect on the family of an addict, it is important for families to receive support themselves. Al-Anon and Alateen (for younger family members) offer help and hope to addicts’ families. Al-Anon holds regular meetings throughout the country for family members to share their experiences, learn from other people’s stories, and be encouraged to find their own strength and happiness.

Family Addiction Therapy

Many drug and alcohol treatment facilities also offer help to families and encourage family therapy. This offers benefits to family members, and it may improve treatment for the addict. Often, families can provide support and resources to help the addict live without the substance. Sometimes the family is even motivation for an abuser to succeed in treatment, such as a mother who works extra hard to overcome addiction in order to be with her children again.

For those family members suffering in silence while a loved-one abuses drugs or alcohol, there is help out there for both the addict and the family. It is important to encourage the addict to get treatment and counseling to overcome the addiction. It is also important for the family to seek counseling or treatment in order to move on with their lives. And even if the drug addict or alcoholic won’t free themselves from the substance, their family members can and should get help so they aren’t left suffering alone with the problem.

Sources
http://www.al-anon.alateen.org/english.html

Holland, Ryan Substance abuse cuts wide, deep November 16, 2008

Addiction Treatment Should Include Family Therapy

This week is National Red Ribbon week, a time set aside for students to learn about the risks of drug and alcohol use. Created in the 1980’s, National Red Ribbon week began in order to create awareness in the U.S. of the dangers of substance abuse. It is known today that many violent acts are connected to substance abuse, and many people throughout the country are now working to stop that trend.

Red Ribbon Week History

In 1985 a Drug Enforcement Agent, Enrique Camarena was kidnapped and tortured because of his work against a Mexican drug operation. His community in California made a statement that year by wearing red ribbons while speaking out against illegal drugs. In 1987, Red Ribbon Week became a national campaign in order to educate others about the risks of drug and alcohol abuse.

Schools Take Part

Many schools across the country now observe Red Ribbon Week as a way to discourage students from using alcohol and drugs. Students Against Destructive Decisions (SADD) now helps out and sponsors many events in honor of this week. Ribbons are still worn, posters are made, fliers are handed out, and announcements are made at schools to create awareness for this week.

Schools use many activities to participate in this week, including pledges to be drug free, rallies, and special reminders for kids to stay away from drugs and alcohol. There are all sorts of ways schools and police departments can cleverly encourage kids to stay sober, including “fatal vision” goggles which simulate the disorientation of intoxication (1), or a “Too Cool for Drugs” day where kids are all encouraged to wear sunglasses to school (2). Still other schools choose to do a balloon release or bring in a guest speaker to motivate the youth.

Positive Peer Pressure

In a time when peer pressure can be very destructive to our students, it is important for kids to encourage each other to make the commitment to stay away from drugs and alcohol. If young people see that so many of their friends don’t use substances like drugs or alcohol, it will be easier for the individual teen to “just say no”.

With the rates of students becoming involved with drug and alcohol use at a high level, it is encouraging to see schools and student groups that are working to curb substance abuse among teens. Groups like SADD are nationally known for the positive influence they are providing for so many young people. Sometimes the message sounds different when it comes from a peer, rather than an adult who is constantly telling kids what not to do. When kids support each other and encourage healthy behavior among themselves, the results can sometimes be greater.

Sources
1) Jensen, Brenda Students Learn About Substance Abuse 10-28-2008 http://www.richmond-dailynews.com/news.php?id=2153

2) Richardson, Hamilton Well-known speaker kicks off Red Ribbon Week October 28, 2008 http://www.prattvilleprogress.com/apps/pbcs.dll/article?AID=/20081025/PROGRESS01/810250312/1041

3) Haas, Harrison Weeklong observance targets substance abuse October 28, 2008
http://www.citizen.com/apps/pbcs.dll/article?AID=/20081028/GJNEWS02/710281781/-1/CitNEWS

As parents, we know it is our duty to keep our kids safe. Safe from mean kids, or bad teachers, or harmful relationships, or drugs or alcohol. We know some kids at school might be bad influences on our child, and we get that we should warn our kids about the drug dealers and strangers on the street. But are you aware of the risks your adolescent faces every time they start up their computer in your own home?

The age of technology

A new Nielsen Online study, conducted on behalf of the Office of National Drug Control Policy (ONDCP), measured the online viewing habits of teens, and tracked their exposure to drug-related content. The findings reveal that one in 20 teens who are viewing online videos watched one or more drug-related videos during a one-month period. The analysis found that more than a third of those viewing drug-related content are under the age of 16 (1).

Kids today have more access to drugs through technology than ever before. The Internet has countless sites that promote drug and alcohol use, that tell kids how to get away with using drugs, and that sell prescription drugs without any regulation. Some sites today even teach kids how to make their own drugs, or how to beat a drug test.

New Legislation

Legislation was approved by Congress last month that would regulate more closely how internet companies sell prescription drugs online. According to this legislation, no company would be able to sell prescription medication without a valid prescription from a doctor that has actually seen the patient.

While this might help with the illegal selling of prescription drugs, there are still all the other sites on the Internet that provide kids with bad information about drugs. The bottom line is that there are many people out there that prey on young people, and are willing to illegally sell them drugs, or give them information that will cause them to experiment with drugs.

Parents’ Job

Parents need to become more informed about their children’s technology usage. It’s not just computers that are the problem, either. Other forms of communication; cell phones, blackberries, and social networking sites, can all be means of easy communication about drugs. Often the information being shared has a message about teen drug abuse that may wrongly teach kids that “everyone is doing it.”

Many parents either don’t know how to use the newest technology, or don’t understand the lingo that kids code their private messages in to make them seem like innocent conversations. Parents need to spend some time on the Internet themselves, checking up on the sites their kids are visiting, and learning about the social networking sites their kids have profiles on. Rules need to be established about what their kids can and cannot do on the Internet, and (as always) be aware of who your child is communicating with, and what they are doing with their free time. It is important that you are aware of some of the many risk factors of teen drug abuse as well.

(1) White House Drug Czar Alerts Parents to Threat of Online Exposure, Calls for Stronger Monitoring Oct. 7, 2008

Rubenstein, Sarah New Bill Targets Rogue Druggists on the Internet Oct. 9, 2008

Fletcher Stoeltje, Melissa Dealing with teen drug use 10/6/08

http://www.theantidrug.com/

How would you feel if your insurance provider told you that the doctors’ visits and treatment costs for your illness were not going to be covered, or that you would have to pay a high deductible? Many people in our country are being told just that, and the reason is that the illness they have is substance abuse. There has long been a view in the world that substance abuse is a choice, or a character flaw, not a mental illness. Things are changing, however, and more and more research is being done on the complexities of the brain and its reaction to substance abuse. People today are beginning to see that while substance use might start as a decision to try something new, it quickly becomes an addiction that can’t be controlled.

Congress approves Mental Health Parity Act

Congress approved legislation last week that would change the way insurance providers handle claims for mental illness and substance abuse. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 provides “equity in the coverage of mental health and substance use disorders by ensuring that group health care plans do not charge higher co-payments, coinsurance, deductibles, and impose maximum out-of-pocket limits and lower day and visit limits.” Supporters of this measure include many in the House and Senate, businesses, insurance companies, and physicians. However, a few questions remained and until last week, it was uncertain whether or not the bill would pass before Congress went into recess this year. By attaching it to the Wall Street bailout bill, however, Congress was able to pass it quickly.

Help is needed

Help can’t come soon enough for many Americans struggling with drug or alcohol addiction. According to the National Alliance on Mental Illness and the National Council for Community Behavioral Healthcare, mental illness is the leading cause, and substance use is the second leading cause, of disability among adults. Many of these adults are not getting the help they need to recover from their mental illness, and often it is because of the high cost of treatment. Another reason is fear of discrimination from their employer if they do seek treatment.

Equal Coverage for an epidemic

With legislation such as the Mental Health Parity Act, those with a substance abuse disorder can be reassured that their insurers will not be able to set a cap on healthcare coverage for mental illness or substance abuse that isn’t set for other illnesses.

In order to deal with the epidemic of substance abuse, we need more good addiction treatment facilities, more affordable health care to addicts, and more support behind families dealing with substance abuse. Through the passage of this bill, those with addiction should be encouraged to move forward and seek treatment, so that we can work toward decreasing the incidence of drug and alcohol abuse.

Sources

Congresswoman Shea-Porter Hails Passage of Mental Health Parity Act September 24, 2008

Many State Reform Initiatives Are Neglecting Mental Illness, Says Study July 08, 2008

Layton, Lyndsey Congress Approves Mental Health Bill Private Insurers Would Provide More Benefits Sept. 24, 2008

Ault, Alicia Equal Coverage For Mental Health?
Many States Require Parity, and Congress May Order It Nationwide November 6, 2007

Curley, Bob Congress, Bush Approve Addiction and Mental Health Parity Legislation October 3, 2008

Monday September 22 is Family Day, a day set aside to remind parents to interact with their children in order to prevent drug and alcohol abuse in young people. While it may seem that as parents we shouldn’t need a reminder to engage our children, but according to statistics, we do. Many parents today rarely see their children because of busy work schedules or commitments. Children are also getting busier with school, sports, friends, and other extra curricular activities. Many families pass each other on the way to the shower in the morning, and that is it. Sometimes when parents and their teenage kids do end up talking, it becomes an argument and no meaningful conversation takes place.

We know we are busy, but what are the consequences of all that running around in the long run? Family relationships begin to decline, parents lose the ability to relate to their kids, and kids begin to turn to other things to keep themselves occupied. Drugs and alcohol easily make their way into young people’s lives when parents are no longer watching.

On Family Day, parents are encouraged to do one simple thing in order to curb drug and alcohol use by their children and teens: eat dinner with them. According to research by The National Center on Addiction and Substance Abuse (CASA) at Columbia University, children who have frequent family dinners are less likely to use drugs and alcohol. In fact, the report says that children who never eat dinner with their families are 61 percent more likely to start smoking or use illegal drugs, and that children who have infrequent family dinners (less than three per week) are two and a half times likelier to have used marijuana and tobacco.

This year CASA celebrates its eighth annual Family Day-A Day to Eat Dinner with Your Children. Parents are encouraged to celebrate their family today, and sit down and have a meal together. President Bush, Governors of all 50 states, and more than 800 cities have given their support to Family Day. Celebrities, politicians, and businesspeople are all dedicating this day to family togetherness.

It seems so simple, eating dinner with your family to prevent your kids from trying drugs and alcohol. The truth is, the more time families spend eating dinner together, the more likely parents are to talk with their kids about issues important to them. By sitting down together at the dinner table, parents show their kids that they are available to them, that they care about them, and that their kids can come to them with questions or problems.

This is not an event that should take place only once a year. Families need to regularly eat dinner together or find time to spend together throughout the week. Family Day is just one way to get us off to the right start.

http://casafamilyday.org/familyday/

Press Release The National Center on Addiction and Substance Abuse at Columbia University Sept. 15, 2008

Sharp, Tammy Westerchil encourages City to celebrate Family Day Leesville Daily Leader September 21, 2008

Metro Drug Commission prepares for Family Day Sept. 22, 2008

Drug and alcohol abuse is a large problem for adults in our world today. But it is probably an even bigger problem for the children of today who are being raised by alcoholics or drug users. These children have to endure a family life that is often unpredictable and chaotic, which can lead to many problems later in life. To think that these children have their whole future ahead of them should cause much concern about how they are being raised today.

Family Life

Many parents that abuse drugs or alcohol will treat their families differently on different days, depending on their level of sobriety at the time. Often the mood swings and changes in parenting that these parents exhibit will confuse the child or make them insecure. Inconsistent care by a parent can lead to a child that either has to grow up quickly and assume adult responsibilities, or one that rebels and gives up trying to do well in school or life. Children in these homes need to constantly be prepared for a parent that is high or drunk, one that is irrational and unable to provide the care that a child needs.

Families that suffer with substance abuse are more at risk for domestic violence, mental illness, divorce, and sexual and physical abuse than other families. These issues are very detrimental and can lead to children with depression, anxiety, and suicidal thoughts. Children in these situations may be withdrawn and have trouble bonding with others. Often they feel that the problems of the family are their fault or that it is their job to conceal the problem, and this can lead to low self esteem, lack of desire to perform well in school, or fear of failure. It would be difficult for these children to make friends because of the fear that someone in the outside world will find out about their secret, or will witness the chaos firsthand.

A vicious cycle

If a child is living with an alcoholic or drug user, the child is likely to develop a warped sense of normal when it comes to using these substances. They may know that their parent drinks too much, or does drugs, but over time, the child may not know what other families are like, or how many drinks a regular person is expected to have in a day. Children of alcoholics are 4 times more likely to become alcoholics themselves, which leads these families into a cycle that is hard to break. Fathers drink to deal with stress in their life, and when their children get older, they have learned that the way to handle stress is to drink.

Dealing with the issue

The good news is that children of alcoholics and drug abusers often develop an inner strength that helps them get through the tough times at home. With much love and encouragement from a sober parent, another relative, or even a social worker or teacher, these children can go on to live happy, successful lives. And of course, the best scenario is if the addict in the family receives treatment and overcomes the problem, and then the child can continue their life and work on a brighter future.

Sources

Treatment Improvement Protocols Substance Abuse Treatment and Family Therapy HSTAT

Fischer, Judith and Lyness, Kevin Families Coping With Alcohol and Substance Abuse

Children of Alcoholics: Important Facts at health.com

Phoenix House Center on Addiction and the Family (COAF)

A huge debate erupted this past week over the legal drinking age in the United States. The debate was sparked by John McCardell (former Middlebury College President) and his Choose Responsibility organization’s call to discuss this issue. More than 100 college presidents are now on board with the initiative, which asks the public to consider a lowering of the legal drinking age.

McCardell and his supporters argue that the current drinking age of 21 encourages young college students (who are going to drink anyway) to hide their drinking; putting them more at risk than if the drinking age was lowered. Supporters of the initiative agree that college officials and parents have a hard time teaching 18-20 year olds about safe drinking when legally this age group isn’t supposed to be drinking. By bringing the issue out into the open and making drinking legal at 18, these supporters believe that they can more effectively educate this age group about making responsible choices about alcohol.

Supporters of lowering the drinking age also argue that 18-20 year olds are allowed to vote and serve in the military, and forbidding them to consume alcohol seems hypocritical and degrading.

Choose Responsibility plans to continue to push for this discussion throughout the country, and they have come up with a plan on how this will all work. The “Amethyst Initiative” is the group’s alcohol education program, which allows for drinking licenses to be issued to 18-20 year olds who successfully complete the program, similar to drivers’ education. Teens who drink before they turn 18 would lose their right to apply for the alcohol license.

Not everyone is convinced. Mothers Against Drunk Driving (MADD) has lead the way for the critics, claiming that these college officials on the list of supporters are taking the easy way out instead of enforcing laws on their campuses. MADD has called for these college presidents to remove their names from the list and partner with law enforcement to come up with real solutions.

Also taking a stand against the initiative is the National Transportation Safety Board, and the International Association of Chiefs of Police, who say that lowering the drinking age would “jeopardize the lives of more teens”. These organizations maintain that increasing the drinking age to 21 in the 70’s and 80’s has nationally saved 1000 lives a year.

Critics of lowering the drinking age say that the way to handle alcohol abuse in 18-20 year olds is to enforce the 21 drinking age and have stricter consequences for adults and establishments providing alcohol to individuals under 21. Another key issue according to these opponents is that colleges need to seriously consider the environment found on their campuses and work to do away with the “college is for drinking” attitude found all too often.

The timing is significant for this whole debate. A 1984 federal law restricts a state’s access to federal highway funds if it sets a drinking age lower than 21, which quickly lead to all states raising their drinking ages to 21. This law is up for reauthorization next year, and there will be much more discussion until that time.

Enos, Gary A. Drinking age law vaults into debate Addiction Professional 8/21/2008

The Right Age for Drinking editorial Washington Post.com August 24, 2008

Henson, Scott The case for lowering the legal drinking age Dallas News.com August 23, 2008

Pope, Justin College presidents spark debate on drinking age Associated Press August 22, 2008

It is a problem that has been around for decades. Adolescents feel stress from personal or family problems, high expectations at school, and peer pressure. One way teens deal with the pressure is to turn to drugs. In the past it was marijuana, LSD, heroin or cocaine that lead curious teens to try drugs. There are countless stories of teens who have suffered severe consequences because of abuse of drugs such as these. Brain damage, seizures, toxicity, and death are only some of the side effects of drug abuse.

With all the anti-drug campaigns in communities today, it seems that teens may be getting the point about the dangers of some of these “street drugs” and are actually turning away from them in some cases.

Prescription Drugs

Today, however there are many more drugs available to teens, and different drugs of choice are making their way into schools and homes. Prescription painkillers like oxycodone and Vicodin® have been used more and more by adolescents in recent years. Many teens today believe there is nothing wrong with prescription drugs when taken once and while for fun, yet statistics show that oxycodone and Vicodin® are the most common drugs involved in fatal overdoses by young people.

The risk with these drugs is that young people do not believe they are dangerous or illegal because they are prescribed by a doctor. Another danger with these prescription drugs is that teens are able to get them for a very low cost or even free from friends or relatives. The easy accessibility of these drugs leads to a higher number of teens getting their hands on them, simply stealing the pills from their parents’ medicine cabinet.

Drugs such as oxycodone and Vicodin®, when used under the supervision of a physician, can be very beneficial to patients. On the other hand, the abuse of these drugs can cause strokes, seizures, comas, addiction, and even death. These prescription drugs can be just as addictive as street drugs, and the effects can be serious on the bodies and minds of young, developing teens.

Prevention

Even though the problem seems staggering, there are ways for parents to help prevent the misuse of drugs in their homes. Parents need to keep track of their prescription drugs, and be aware that their children may be able to get drugs from family members or friends very easily. Parents should talk with their children about the use of medication, and alert them to the severity of abusing prescription drugs.

While it seems that many anti-drug campaigns have been beneficial in the past, funding is becoming an issue when it comes to teen drug prevention. Every year, Congress gives money to states for drug treatment prevention, allowing the states to divide up the money among some of the programs they wish. A recent trend shows many states often spend very little of the money on adolescent drug prevention. With the new problem of prescription drug abuse in teens, it seems it is important that organizations that educate teens on prevention and treat teen addicts would receive funding to continue to fight this national problem.

Sources

More Kids Dying, New York Times July 18, 2008

Heroin’s Hold on the Young, New York Times Jan. 13, 2008

OxyContin, Vicodin Grow Popular as Teen Drug Use of Choice, Think and Ask nonprofit news February 2007

Teens Turn Away from Street Drugs, Move to Prescription Drugs, New Report Reveals ONDCP Press Release February 14, 2007

Rx—A New Intentional High for Teens National Youth Anti Drug Media Campaign, Greater Dallas Council on Alcohol and Drug Abuse 2006

There is not necessarily any rhyme or reason to it: some children become addicted to drugs and alcohol. While there are genetic and social factors that can increase or decrease the likelihood, the fact remains that both good and bad parents can wind up with an addicted son or daughter. Now, your child will most likely not simply come out and tell you that they are abusing drugs or alcohol, so here are a few signs that should warrant your attention:

• As stated above, genetics do play a factor, so be alert if your family has a history of abuse.
• Have you seen evidence of their abuse, i.e. empty liquor bottles, marijuana joints, or other drug paraphernalia? Children generally try very hard to hide these things, and if they are found easily, it could be a sign that they are losing control.
• Has your child been showing a drastic change in behavior? This could be a loss of interest in family activities, loss of appetite, change in friends, depression, irritability or defensiveness, or many other signs.
• Is your child having money problems but won’t talk about them?
• Has your child received a DUI, or has he or she been involved in shoplifting or theft?
• Do you notice any burn marks on their fingers or lips, needle tracks, or sores on their face and nose?

If you do notice some of the above things and suspect that there is a problem, be careful in your reaction. Harsh punishment or lectures to your child may simply drive them further to abuse. So what can you do about it?

• Resist yelling. Try to create a healthy, positive atmosphere in your house.
• You can’t control your child; you can, however, control yourself. Focus on that and your dealing with it, rather than forcing your child to change.
• Sit down and discuss the boundaries of the home with the child. Explain reasons for them and consequences for their actions if disobeyed.
• Get your son or daughter enrolled in a rehabilitation program and be patient. This does not happen overnight. You may not be the factor that produces change, but rather your child’s experiences with other recovering addicts. It will take time.
• Keep a hopeful, positive attitude, and have a sense of humor. Overstressing over the situation only leads to a hostile environment, which will not produce the change.
• Get help yourself: for co-dependents. You’re not alone, so it’s important to help yourself recover as well as your child. You may need family addiction treatment.

It can be frustrating. You may be ashamed, or resent your child for acting the way they have been. The important thing to understand is that there is hope, and things can turn around – it will just take some positive action and a little patience.