It’s Hard to Reward When They’re Always Using

Lovely and her family are embracing CRAFT principles more and more. But rewarding feels complicated because her Loved One uses pills, seemingly 24/7, and the family is unsure of exactly what substances are in the mix.

"How can I apply rewarding behavior for non use when my daughter is on prescriptions all the time and lives on her own? I really can’t tell when she is not using them, unless I happen to suspect she’s in withdrawals from not getting one of her prescriptions? She is using multiple prescriptions and has had an overdose recently and does not think she caused the overdose. She was even mad at the medical staff for keeping her there for 3 days and cutting her clothes off to treat her. I believe she had a life threatening seizure but would not allow any of the doctors at the hospital to talk to me. Our family is working on a treatment plan and an invitational intervention and our hope is that she will attend and get the help we are offering. She has been very responsive to our attempts to invite her to do things together such as exercise, come to be with family for Thanksgiving, play virtual reality games with her brother, etc. But we can never really tell when she is not using. She’s admitted she’s dependent on the prescriptions and to a person outside the family that she knows she is in trouble with drug use and needs help, but has said nothing to family. I’m encouraging our intervention team to sign up for Allies in Recovery and learn all they can, hopefully they will. We all agree that she needs help and cannot afford to pay for it herself and Medi-Cal coverage is absolutely appalling. Thank you for any insight you may have. Blessings."

When your Loved One always appears high, it's hard to identify non-use

It is indeed hard to separate "use" from "non-use" in your Loved One when you don’t spend much time with them or when they appear to be always high. Your daughter is dependent on those pills, and she is also addicted to them. She is dependent because stopping causes withdrawal; she is addicted because she is playing with the drugs, taking too many, combining them, in short “acting addicted.”

You don’t know what she is taking, though the recent overdose and the risk of seizure suggest one of them is a class of drugs known as Benzodiazepines. These, and alcohol, are the most dangerous drugs to withdraw from, causing life-threatening seizures that must be watched for. Did the emergency room do blood work? Do you know what else was in her system when she overdosed?

Use the exercises in Module 3 to get more clear on their patterns of use

The Key Observations exercises in Module 3 help you build your awareness and encourage you to document your observations. Don’t skip these exercises.

You have some ideas of what your daughter is like in various states: when she is high; when she is just okay – perhaps using just enough to "maintain" and not get sick; and when she is in withdrawals.

It’s tricky in your case, because your daughter is probably using a couple different things. Are they all prescribed by a doctor? I'm only guessing as to the benzos, and an opioid is another guess — though these drugs have become much harder to get from a doctor.

If she is taking opioids, she would quickly need more than a regular prescription amount. Do you know if she is going to dealers or the streets to buy drugs? Additionally, does she have a learning disorder or depression/anxiety? Perhaps there is an ADHD drug or an antidepressant or antipsychotic in the mix?

Your instinct is right: you will need more specificity. I know this is hard with her, but your family will benefit from learning more/doing some educated-guessing, to assemble as much of the bigger picture as you're able. Follow our Key Observations exercises in the Learning Modules. Some of the lists and suggested answers can help open your eyes.

All this being said, it is still possible that given your physical distance from her, and the nature of the substances she is misusing, you may not be able to gain clarity on  when and what, precisely, she is using. If this turns out to be the case, put Modules 5 & 6 aside for now (the modules that address rewards for "use" and "non-use") and continue to apply what you're learning from the other modules. There is a lot in the eLearning that will still improve the situation with your Loved One, including communicating better and putting together a list of treatment options for her.

How can our family move forward with CRAFT now?

1) Start with those exercises in Module 3.

2) Then read the piece in the Resource Supplement that addresses what you can do when your Loved One appears to always be high on something.

3) I love that you’ve assembled an intervention team. Welcome, team! We can all use a team. Thank you for being willing to learn an approach that will hopefully make sense and allow you to all get on the same page.

CRAFT online: Give yourself 6-8 weeks to start really seeing results

We ask that you give us 6-8 weeks, to walk you through the steps of CRAFT and to give you time to practice.

While things continue to soften between your family and your daughter, you’ll need to be working on that list of treatments. State-funded treatment can be uneven, but so can private-pay treatment. It may be that having state Medicaid actually provides a better chance of finding affordable and available treatment. Don’t forget the benzodiazepines when formulating your plan. If those are in the mix, she will need a medical detoxification to start. If she is taking an opioid, medication such as Suboxone is the most protective against overdose.

Our colleague Cathy Taughinbaugh may be able to help you with exploring treatments in CA.

Can the family afford to pay anything towards your daughter’s treatment? I always ask the question. Sometimes a distant relative steps in when asked.

Welcome to you all. We are here alongside you.