Their Influence Is Ruining My Efforts

Fireweed3’s Loved One was supposed to come home but is back on the streets, using and engaging in dangerous behavior. In her recent comment, Mom unravels the dynamics of her daughter’s substance use disorder and wonders about how to navigate communication with an important player in her daughter’s life whose influence has not been a positive one thus far.

"Thank you as always Dominique.

I'm going to respond to a few of your statements, and then give you (and others) a quick update.

Your insight: "If you focus on the need for the boyfriend to go, and say so, your daughter will push back, argue about her rights, and so on…She hangs on more tightly."

I agree. I learned that lesson the hard way. (Review my posts from fall 2018!) Today I try to remain neutral about the boyfriend/relationship. When she talks about him, I avoid giving it any additional energy. When she expresses frustration about him and/or their lifestyle, I try to listen with reflective statements. When this leads to change talk, I lean in with a bit more warmth/affection and "reward" words and actions that align with health, safety and a desire to be well."

Nice work. What a sophisticated use of the communication skills you’ve acquired over the years. Remaining calm in your manner is also key here, helping you and helping her. Not reacting to your daughter’s love issues when every ounce of you wants to shout, cry, explain, warn…is on par with winning an Emmy!

"With this said, I am struggling to accept the differences between my approach and boyfriend's mother's approach. Note: I am dear friends with boyfriend's mother. I love her AND I worry that my CRAFTy strategies are (inadvertently) undermined by her support of the relationship. She views the relationship as a positive in her son's life — a potential path out of darkness into recovery. He is 5 years older, has been using significantly longer, and has received very little in the way of treatment. I agree wholeheartedly that by using together, they are engaging in harm reduction. But that is where our common ground ends. I've shared CRAFT with her, but things don't seem to be shifting. Recently, she reassured my daughter that her son loves her. Sadly, my daughter had been planning to come home and get back on track in the days and hours leading up to this diversion. Can my CRAFT efforts work when other forces are directly working against it? I imagine this may also happen in 2 parent households, when one parent is guided by CRAFT and the other is not. How does this work? How CAN this work?"

We all have ideas of what will work for our Loved One. Some of us know our limits, but many of us over-do, under-do, or don’t-do. When it comes to someone so deeply important to us, most of us could benefit from a basic training that teaches us how to respond to our Loved One. The communication skills you are learning through CRAFT require objectivity and perspective. This, in itself, needs practice and commitment. 

Family members are challenged so often, pulled around by their Loved One in all kinds of ways. How you react and feel about it is up to you. You need a trained eye to carefully and objectively observe your Loved One. Are you seeing the patterns better or maybe earlier? Can you spot your Loved One’s intentions? Can you step back enough to see it all a little more clearly? Can you respond with a touch more empathy and wisdom? Can you protect your own mental health as your loved one bumps around in their (often insufficient) efforts to address the substance use?

Our hope is that all family members watch the program on this site and respond in a more united and informed manner. So, perhaps it’s time to use the intervention skills (Module 8) or practice making a request (Key Observations Exercise 21) and formalize your request to the boyfriend’s mother. Use what you’ve learned from us and apply it to get your friend to look at the site. This way you will both have the tools to communicate better with your respective Loved Ones. At the moment she is at a disadvantage here, not having the knowledge and communication skills you have. The goal would be for the two of you to be moving in the same direction, feeding off of each other. In the process, she could even bring a fresh new take on your situation.

"Your insight: "Also, it’s worth noting that taking opioids may be linked to your daughter’s eating disorder. You eat less on these drugs, and at times you vomit, and so you lose weight. Many drugs also curb the appetite."

YES. My daughter said the same thing to me. I also heard this from a local addictions therapist. So while she's not using (as many) stimulants, she continues to use opiates to purge food/calories. Everytime I see her, she asks "Do I look fat? I feel like I've gained weight." I'm deeply concerned that by not treating the underlying eating d/o, she will not get well. (Amy Winehouse comes to mind, as do others.)"

I think your instinct is spot on and you are looking at one of the pillars of your daughter’s substance use disorder. So, ideally, we locate an affordable quality program that treats both an eating and a substance use disorder in an integrated treatment plan. Your home might simply not be enough for her, given that her substance use disorder is so intertwined with other complex, underlying issues. I think she needs professional care. An inpatient treatment center with a team that includes her at the table would be best.

In your response, you outline a plan for her to attend Dialectical Behavior Therapy and live at home. This may be the only affordable choice, even though payment for even this is drying up. Can you talk to the program about a scholarship?  Can your daughter’s dad be convinced to pay for treatment?

As I write this, I’m worried for you. This is asking a lot of you when you are giving so much already on a daily basis. One last suggestion:

"Your suggestion: "You are in a unique position to allow her back in your home with a chance to revisit and refocus on the plan you made together over coffee. Can you frame this so that the help with eating disorder/ DBT is her job – essentially saying that it's more important to have accountability for this work before trying to hold a job down at this point."

This is what she and I discussed — DBT IOP for eating d/o in lieu of going to school and/or working. Three months of treatment, 8-12 noon. Sadly, her child support dries up in two months so I can no longer offer this option. If she moves home after she turns 21, she will have to contribute somehow (work). In early recovery, she easily becomes overwhelmed by tasks. Developmentally, she seems to have regressed. Prior to spiraling out, she was an honor student juggling AP classes and employment, on her way to a scholarship at a local university. Anyway, she's in for a surprise if/when she comes home now, as she will have to work while engaging in DBT treatment.

Your insight: "Understanding the patterns and nature of her partnerships is something she will inevitably have to reckon with along her path to recovery."

Yes yes yes. I believe her need to be in relationship (at any cost) is due in part to her attachment disruption with her dad. She tells me she wants a therapist to help her address trauma/attachment issues, but during active addiction, she is completely unaware of time. To her, 3 pm is morning and midnight is dinnertime. Sunday is Thursday. May is March. Any work around relationships will have to wait, unless she has a burst of insight while using – and is capable of following through with therapy appointments. (She even misses phone appointments, which is why Kaiser no longer prescribes suboxone.)"

We are proud to participate in launching the 5Actions.com Program, our sister site focused on the self-treatment of addiction, developed by our colleague Dr. John Fitzgerald. Like Allies in Recovery, 5-Actions is all online, and filled with evidence-based teachings about addiction for the person struggling with substance use. It is free during COVID-19. Dr. Fitzgerald focuses on attachment and trauma. This program has excellent learning modules and could help your daughter gain focus. It is low-hanging fruit, in the sense that it is practically barrier-free, doesn’t cost anything, and can be viewed at home on any device.

"Long way of saying: She did not come home as discussed, and continues to use heroin and pressed "oxys" (fentanyl). She is also engaging in risky behavior to raise money for drugs. I fear further trauma, and even sex trafficking. I am scared. I am trying to practice self care — meditation, prayer, gardening, quiet walks in the evening, virtual connections with friends. I ordered some blank journals from Amazon. It's all I can do, other than be there for her, as you stated above.

Thank you again. Your support is like a lifeboat to me."

How incredibly brutal this all is. We are here for you and want to thank you for everything you are doing. Even though you and your daughter’s situation is so challenging, you are doing so well. You are mastering the communications skills you need to help your daughter, you are calm and enlightened in your stance, and you give her love and compassion. You have understood that self-care is a major part of your making a difference in your daughter’s process of recovery. You've learned so much and we commend you for it. The meditation, the gardening, the journaling are aligned with placing the focus on you, which is so essential in this process. Practicing self-care is fueling you and keeping you centered, more ready for the challenges ahead of you. Our hearts go out to you and we are sending you love and strength for the upcoming challenges you both face.