He Says He’ll Quit Then Keeps Using

mariecat is faced with trying to shepherd an adult son into treatment after having lost his brother to SUD. She is frustrated at his behavior — he says he wants to quit, then keeps using. He says he's interested in treatment, then says he can't go because of his job. With these roadblocks, and from out of state, where can she begin?
 

"My son has recently relapsed on opiates. He is 31 years old and lives and works in another state. He won’t quit his job and go into treatment / lose his apartment. He thinks he can alleviate his cravings with Suboxone that he buys illegally on the street. He says he wants to get off drugs and wishes for a better life. (recent DUI scared him into wanting to stop).

But whatever he is doing isn’t working. I’ve tried to get him to reach out to NA meetings for help, but he says that never helped before.

He just continues to say he will stop using drugs but then does drugs and says tomorrow he'll quit. Can seem to get through to him about finding other resources. I don’t know what resources to suggest because he lives in another state/ California. He also has no health insurance at present although he will pick it up Jan 2021 with my help."

Your situation has much in common with those of other members

You're in the right place, mariecat. CRAFT, and the Allies in Recovery program are ideal for family members dealing with situations like the one you describe:

• "whatever he is doing isn't working";

• "he just continues to say he will stop…then does drugs and says tomorrow he'll quit";

• "I don’t know what resources to suggest because he lives in another state"…

The CRAFT method, on which our program is based, was designed specifically for family members whose Loved Ones are resistant to the idea of treatment. Success rates (in getting that LO into treatment, getting them to stay longer, etc.) are very high in all studies of CRAFT, and also in our experience with members who work our program seriously for at least 6-8 weeks.

Communicating in a new way when emotions are intense

From your first comment, we know that your situation is complicated emotionally, because of your devastating loss, of another child, to SUD. Laurie MacDougall responded to you in this post, which we hope you found useful: https://alliesinrecovery.net/discussion_blog-i-lost-another-child-to-sud-im-too-sad-to-move-for

I imagine that his pain and hard feelings around the loss of his brother, the biting awareness that he is struggling with the same problem that took his brother's life, along with the "loaded" nature of any conversations he may have with you two (because of everyone's grief, and perhaps your fear for his life) could certainly make for some difficult communications. 

Module 4 ("How Do I Talk to My Loved One?) is where we spell out the best communication habits to adopt with an addicted Loved One, and which ones to be wary of. Until communications get smoother with your son, Module 4 is your best friend. We highly recommend watching modules/doing the associated exercises several times, as they are chock full of information and new ways of thinking.

Focus on building a bridge to create a stronger relationship

Really shift your focus to bridge-building; as part of this, you'll avoid making suggestions or sending information and resources. While well-intentioned, this actions often leave our Loved Ones feeling overwhelmed. This often leads to their pushing us away.

The goal is to learn the communications skills so that you become really well skilled in LISTENING for those moments when your Loved One is wanting to do something different and HEARING what is it that they are willing to do.

We, the family members (well, pretty much all humans), hate unsolicited advice; our Loved Ones are no different.

Because of the trauma you have experienced, it's possible you feel an urgency to find solutions, to respond immediately, to your Loved One.

Allies members currently have two easy-to-access and free groups they can attend to work on communication with a Loved One and processing the difficult feelings that are there.

Kayla Solomon runs a group on Wednesday evenings (6:30 PM) and Laurie MacDougall runs several weekly REST groups online. You'll be able to work on all these skills and to hear the creative and multiple ways to employ them.

Buoy yourself by recognizing all of the positives

I just want to start by saying that in your short comment, we really see some positives. Searching for the positives is not an easy task but the more a person can identify the positive and stay focused on it by rewarding, the better the outcomes. Both the Loved One and you, the family members practicing CRAFT, will feel better. Here's what we noticed:
 

1.    He feels strongly about holding onto his job; this is most likely a good thing, as it is a source of stability for him. 

Thus, you and your husband can make a point to praise and encourage this desire, and (in your research on Treatment Options) look for outpatient treatment near his home or work. As we underline in Module 8, it is the family's job to research treatment options, and put together that list. (Other families on this site emphasize that it is important to become skilled at Module 4 before presenting options for treatment. Timing is so important here. Jumping to treatment talk too soon before improving communication skills can lead to the Loved One being less receptive to ideas.)

Somewhere on the list (or verbally) you can make a point of letting him know you really respect his wanting to hold onto the stability of his job (or, insert other words that apply to his relationship with his work – recognition, usefulness, intellectual challenge, etc) and that you've focused on outpatient and online treatment alternatives in the resource suggestions you put together for him.

2.    He is already seeking to regulate cravings and opioid use by taking Suboxone, an agonist treatment medication, albeit street-bought. He has a better handle on his cravings than many, as he has already improvised a use-reduction strategy for himself, probably to help function on the job. It’s a wobbly strategy, unlikely to work for too long.

The reach for street-bought Suboxone however, as a maintenance drug, suggests an entrée for when you do talk treatment.

It is but a small hop from street-bought Suboxone to Suboxone dosed out by a clinic, especially if it can be paid for by insurance. Your son may be hanging on to his present strategy because he mostly feels his workaround is working. Though there is the DUI; the potential loss of job and the apartment, as consequences.

As mentioned above, in Module 8 we talk about change talk, as the best moments to talk about treatment. Can you get started right away figuring out where your son could go for Suboxone, and get that door open to him: cost, insurance, wait list, hours, procedure…

Here's a suggested prompt to use in that moment of a "wish" or a "dip":

I wonder if getting a regular dose of Suboxone from a clinic would keep you from X (dip), or get you to your goal of Y (wish). I did some research and found this one, near your house, insurance will pay starting in January, and in the meantime we can pay out-of-pocket, etc.

(You hand him or email him all the details he needs to get into the clinic, including the money paid in advance or at the time by you if necessary).

Can you pay for the clinic until the insurance kicks in hopefully in January? Ask the insurance company if they will pay retroactively for the MAT clinic. Getting on MAT is an important early step for your son. It drops the risk of overdose by 50%.

Now, he may not want to stop using, getting street Suboxone as needed suits him just (almost) fine for the moment. You’ll need to thank him for listening and back away. But now he has the information. This greatly improves the chance your son will likely walk in, in a moment of despair.

Tack onto the paper/email on which you have the details of the MAT clinic, our list of links to online addiction support groups from the Resource Supplement. Meetings of every flavor are being held virtually, thus widely accessible.

3.     The recent DUI represents a "Natural Consequence," and as often happens, you describe this having sparked a desire in him to get help. Wonderful. Especially if no one was harmed in the process.

Our program spells out how to watch for/listen for change talk (a "wish" or a "dip" and how these are the absolute best, most appropriate, times to speak of your desire to help them with treatment), and hand over the list of resources you've been gathering. 

mariecat, you've been through so much. Many parents would be tempted to throw in the towel right now, given everything you've experienced. But you're on this site, you found this program, and we believe from reading about your son that he could be close to actually getting some good help. Please think about working this program in a committed way (we recommend 6 – 8 weeks of steady learning and practice) — we really think you could tip the scales in your favor.