Am I Loving Him to Death?

Her username says it all! Allies in Recovery Mom WitsEnd wonders how much to help, or not help, with her son's addiction(s)—from opiates to antabuse and suboxone then back to opiates…

"Hi, My son is 37 and has been struggling with opiate addiction since he was a teenager. He has been on Suboxone for about 6-7 years, which was helpful for a while, but then he started drinking and became a severe alcoholic, then was prescribed Antabuse, along with the Suboxone and before long started back on heroin again. This run has been going on for about a year. He lost his job and can't pay his rent so he is being evicted. I offered to store some clothing and drive him to a detox. He keeps stalling me and now wants me to drive him to detox and pack up his stuff at the rooming house for him. He has zero coping skills and refuses to go to any substance meetings or counseling, etc… I want to help him, but his plan is that I do it all for him. I've had enough and know that I am loving and helping him to death, literally. His Dr feels that the suboxone is like insulin for a diabetic and just keeps falling for the bs story that my son feeds him. He uses for 3 weeks then detoxes himself with subs the week before on most months so the tox screen is generally negative for opiates/fentanyl. I don't know what to do anymore."

Medication assisted treatment (MAT, in your case suboxone) for opiates is rarely enough on its own. We have said this before. It is a critical first step to facilitate withdrawals from opiates and to reduce cravings. Unless other treatments are used in combination with MAT, however, there is a likelihood that the person will start to, or continue to, use other drugs. I am fond of saying that when I was on Naltrexone and Antabuse, I had (scarily real) thoughts of snorting the little white specs in the carpet. I was so desperate to get high on something. I smoked pot, whose high I disliked. I used cocaine, which I was also not fond of, and for which I had to take benzodiazepines to come down from.

For some, this desperation for other drugs may reduce on its own, or with the counseling that is supposed to accompany the medicine. For others, like your son, this is simply not enough. The opiate problem will become an alcohol or cocaine problem, and, as has happened for your son, one may turn back to heroin and stronger opiates.

MAT providers are there to help, but their reach into recovery is limited. It’s a biomedical response to a problem that goes far beyond biology.

Here are some actions you can take:

• If the MAT provider really doesn’t know your son is abusing other drugs and heroin again, tell him/her. Without a release, he cannot talk to you but you can say what you want to him/her.
• Your son is getting urine-tested once a month, which is simply not enough. Tell the MAT provider. If your son is abusing his suboxone, the prescription renewals should be shortened. If he continues, your son could also be redirected to methadone, which is much harder to abuse and will require daily visits for dosing until urine tests are consistently clean.

The response to opiate addiction must be more comprehensive: MAT, safe housing, psychiatry, work on the daily skills of life, relationship and family skills work, relapse prevention, psychotherapy with evidence-based approaches (like cognitive behavioral therapy or dialectical behavioral therapy), involvement in a community of peers, exercise.

Here's where I think things are a little confused. We are pushing hard to get anyone, at any stage of opiate use, into MAT. All good. But there is a real difference between someone who has been using only opiates and only for a short time, and someone who is quite progressed in their addiction to any drug. For people in the latter group,  lifestyle, thinking, and physical addiction are entrenched. A multipronged approach is needed to pull them out. Someone who never had a problem with addiction and who unwittingly became addicted to opiates from pain pills for pain, and has been using just these pills for a short time, is in no less danger, but may have more success with the MAT + weekly counseling treatment alone.

In a recent conversation, a high-ranking official in substance abuse let me know how frustrated he was with the narrative that dominates discussion of the opiate epidemic: it is often suggested that somehow (mostly white middle-class) people addicted to opiates fall haplessly onto the drug, never having regularly used or abused other drugs prior, like pot or alcohol. Addiction goes into overdrive when a drug like an opiate or cocaine is discovered. It shortens using careers because it causes so much more havoc, but it is rarely the first drug of abuse in a person’s history, despite how media like to represent it.

If we think multipronged and we advocate for this, we are more likely to see this happen. I see how often families are having to take responsibility for advocating for comprehensive care.

Your son wants you to do everything for him. When it comes to treatment, I suggest you do this. This is where you extend yourself, where you can step in while maintaining your boundaries. Go box up his things and help him into detox. Push for him to follow up the detox episode with inpatient care, transitional living, and more therapy if you don’t see it happening. Wrap every service around him that you can find and for which you can get him to agree.

If he doesn’t agree: find the names & addresses, write out the details, and give it to him, with a promise to help any way that you can, when he’s ready.

There is no way to know if this treatment episode will wake him up and help him decide that he is just sick of himself, that he is willing to do a little more.

Finally, self care! self care! self care! Go to the sanctuary on this site for some easy tidbits. Do what it takes to get your energy back. Your son wants to go to detox. That is a huge, important sign. Our thoughts are with you.