Do I Have to Kick Her Out?

Sophie's daughter uses every night and sleeps it off all day (at home). They've been strict about not providing money or rides… but Mom is afraid that if she disengages completely, her daughter will be alone in the world and perhaps in greater danger.
 

"Hello AIR,

One month ago our eighteen year old daughter relapsed after immediately coming home from a seven month residential treatment program. This was her second experience of a relapse immediately following treatment. (We live in a province in Canada where there are no structured AfterCare programs.) Her diagnosis is concurrent disorders of PTSD (based on childhood trauma) and substance use disorder (intravenous heroin). Every day for the past four weeks she has stayed in bed asleep for most of the day and gone out in the evening (presumably to get her drugs). When she comes home at night she sometimes talks about stopping, or about wishing she could just open her eyes and be in a new place and be at college full time, but the following morning it is too hard for her to act on anything and the cycle continues. I have always tried to follow the CRAFT approach, but until I just joined AIR last week, I had not heard about the idea of distancing myself as a means of motivating behavior change. We have established strict boundaries and are not giving her ANY resources, rides, support, etc. unless it is directly related to her recovery, but I find it difficult to believe that distancing myself is going to be helpful. She has already distanced herself from everyone who loves her and whom she loves, and my husband and I are the only people she has a positive connection with. He works out of town so I am the ONLY person left and if I distance myself, she won't have anyone. I would appreciate any advice. Thank you."

Learning Module 4 describes what you can do when you see your Loved One is not using. In a word, reward! This can include your presence, your attention, a dinner, a loving gesture. But when your Loved One is using (including just before they use, while high, or in withdrawal), you want to remove rewards, allow natural consequences, and disengage. You are a reward, even when you are naggy or angry. You are their anchor; you signal things are normal. Disengaging yourself signals things are not okay. You go to your room. Leave her alone.

CRAFT was designed to address interactions, in the short-term, pretty much in the moment. One day your Loved One can be high on drugs, the next day he or she can be trying to refrain from use. Your behavior rides along behind this, reacting to how you find your Loved One.

Avoid sweeping decisions

We suggest you avoid sweeping decisions over longer periods. Your Loved One is always shifting, as should you. This is hard to do, but it is the power you hold to influence their behavior. Telling your Loved One not to come back until they've kicked the habit is a lose/lose situation. You miss the moments when they are ready to try to stop, when you can help with treatment, and they miss the help line you offer by maintaining that bridge of communication between you.

Over the years of coaching families in CRAFT, we have learned to apply its short-term principles to the larger picture, including whether to allow your Loved One to stay living at home, financing the car, college fees, and help with rent, to name a few.

How do I provide rewarding rewards, that can be easily removed?

Again, it's important to think out how to provide these resources as a reward but in a way they can also be removed should your Loved One be actively using and resisting treatment.

A suggestion we have made before is to put a day bed in a common room with a foot locker. Turn their room into a meditation center, a place to stretch, an art room for yourself. When they are not high or drinking, the day bed is there. When they are high or drinking, ask them to wait until they sober up before coming home. The day bed is temporary, figuratively and literally, more easily given and taken away.

Your daughter is in what sounds like a rigid pattern, using every night, and sleeping it off during the day. When there is no break in this pattern, disengage yourself. Offer her the day bed if you must. Ideally, tell her to come home only when she is willing to not use or to explore treatment again.

I live in Canada part-time and I see how limited substance abuse knowledge and treatment is up here. Even AA/NA is limited. Hopefully, you’re in the city where services are more available.

Your daughter needs to go back to treatment. Two treatment episodes didn’t work. She is in danger of overdose and should consider medication-assisted treatment (MAT), at the very least.

Home = a reward or enabling use?

Whether home is a reward or enabling use is determined by the context. If your daughter is not willing to consider MAT or further treatment and is using your home as a free comfort station, while the few bucks she has is spent on drugs, then consider whether the situation is helpful. We are not suggesting you stop communicating. We are suggesting you consider the resources you are providing and how they influence her use.

Thank you for writing in. Your question is at the heart of CRAFT.