Building a Bridge to Her Heroin-Using Daughter
Member Chicagomom’s daughter is using heroin—possibly a great deal of heroin—but has also expressed a wish to get into treatment. Our member wants to do everything she can to help that wish become a reality. She’s heard mixed opinions about how best to stay in touch, however. What sort of communication with her daughter is best right now? Dominique Simon-Levine walks her through the answers implicit in CRAFT, and has some further ideas for this case in particular.
“My daughter is using heroin. She doesn’t live with me, but she is in the same city—in a dangerous neighborhood, I might add. She does text me daily, so I am wondering how to keep in touch. We had a “love-first” intervention that didn’t get immediate results, but she does have an intention to go to rehab (in the fall, she says).
“The counselor for the intervention said that any communication with her that does not involve a conversation about rehab is enabling her. I worked through some of your modules, and I see that these conversations could be considered rewards. I want to stay in contact with her, but I am not sure how this should work. I think she is using heroin all the time so that she doesn’t withdraw. I am confused about when I should communicate with her. In the past I would try to get ice cream with her or something like that. It’s a bit complicated right now because my mom just died. She was very close to my mom and is grieving, and it seems cruel not to support her for that.”
Our sincere condolences for the loss of your mom. Your daughter was close to her and is also grieving this loss. We don’t want you to do anything you feel is cruel in this fragile time—or ever, really.
Positive communication is never a mistake
In no way should you cut off communication with your daughter. So daily texting is good. A phone call is good. Ice cream is good. It’s all good.
CRAFT has a built-in, psychological, and well-studied understanding of the importance of communication in your ability to influence a Loved One into treatment. If nobody’s talking, if communication isn’t fostered and maintained, who will your daughter turn to when she is too sick to act and advocate for herself? Even if you do no more than text her, you’ll be increasing the chances that she will trust you enough to say when it hurts. It is through maintaining communication that the window opens, a Loved One’s own motivation for change pokes through, and they talk about the hurt and the help they may need. You might want to review the CRAFT approach to getting a loved one into treatment (Module 8).
She’s got a recovery plan. Can you start supporting it today?
The counselor was able to get your daughter talking about addiction and the need for treatment. Your daughter has agreed to go to treatment later in the fall. I like this because it is her saying, “This will end. I have a plan to fix this by fall.”
Later this fall, however, is too far away for my liking. So let’s add what you can do this week, even today.
We spoke briefly, and you have already started finding an inpatient rehabilitation program for the fall. Ask about a waitlist, the admissions process, and insurance pre-approval. Watch out for pre-approvals that only cover a small number of days. The family and rehab end up fighting the insurance company for the entire stay. If she were coming in “any day now,” how would that work? Does she call? Can you hold a spot? Print it and text the list to her.
Did the counselor help create a list of options for your daughter to address her heroin addiction? Any such list should include medication, a detoxification unit, a residential program, self-help, outpatient therapy, recovery centers, a recovery coach, and specialized help for co-occurring conditions like past trauma or issues with food.
The choices are hers, but your role is crucial
In Module 3, we talk about building a bridge between you and your daughter with CRAFT—and then maintaining it, so that when your daughter’s ready to try a program or self-help group, you are the one she informs. You are the soldier at the ready, prepared to help tear down barriers (insurance forms, pet care, rent, etc.) to make that door open as wide as possible.
Absolutely stay in touch with her. Talk about everything EXCEPT for treatment, until you feel the moment’s right to touch on that subject. Keep it light. If she’s noticeable high, beg off, whether it’s a text or call.
Treatment talk happens only when a window opens for that talk. Module 8 talks about how to spot that window: a wish or a dip in your Loved One’s outlook. Something makes them want to reach for more in their life (wish), or something dampens their outlook (dip).
Your daughter is contemplating a change a few months from now, when she will stop using heroin and go into treatment. Let’s nudge her gently towards taking some action on that decision today.
Medication is urgent in your daughter’s situation
I am not a doctor, but I recommend that your daughter start right away a medication for opioid addiction. Look at Suboxone, which is easier to access and is a less highly controlled substance than other options. Suboxone reduces overdose deaths by 50% and will take away withdrawal symptoms and help with cravings (here are some further, first-hand reflections on Suboxone). It has also been studied for use on chronic pain, which is the other thing you mentioned in our phone call. When you feel the time is right, you might try something like this:
“Hi dear: I’ve been working on a list of different types of help for you when you’re ready. Have a look. I included a few new ideas, including Suboxone through a clinic. Here’s an article that looks at Suboxone and chronic pain.”
Getting into treatment is hard work, Chicagomom. Even with low-threshold treatments like a Suboxone clinic, your daughter may need you to help navigate.
You are reaching out, asking for help, and learning all you can about how to help your daughter. We are here and are glad you are on this site. Thank you for writing in. Let us know how it is going.
Chicagomom and Dominique Simon-Levine have remained in touch since the original post. Here’s the continuation of their exchange about Chicagomom’s daughter:
Welcome back, Chicagomom. Thank you for sharing your progress over the past couple of months. I want to commend you on your follow-through with CRAFT—well done!
In your original post, you expressed concerns about how best to communicate with your daughter in a way that “builds a bridge” and helps to guide her towards recovery from her heroin use. In subsequent posts, you shared that you suspect a history of trauma, as do I. She had anorexia as a teenager, and this tends to reactivate periodically. She is showing a lot of the signs associated with trauma and is likely re-traumatizing herself through her current behavior, which includes illegal activities to support herself. The good news is that she is still saying that this life is “temporary”, which means she is willing to stop. You are looking together at a program in Florida called FUTURES. She does worry about her dog licking her face if there is heroin on it, and in general worries about something happening to him, so that’s a real concern of hers and a possible motivation for change. You’re waiting for another wish or dip.
First thing we need to do is put together a more complete list of treatment options.
Allies helps this mom put in place a treatment plan (Module 8)
I contacted Futures to see if they allow patients to stay on Suboxone while they treat pain and addiction. They said no. Your daughter would have to be weaned off the Suboxone beforehand. But here are some resources and information on Medication Assisted Treatment (MAT) and treatment program options.
You might start by looking at this article on treating pain in patients with substance use disorders: it gets a little technical, but I think you’ll find a lot of interest. Another useful article talks more specifically about opioid use and chronic pain, and argues in favor of Suboxone. Recent advances in the treatment of pain are worth considering as well. And here is a long-time, well-regarded program that claims to treat pain as well. With this one, as opposed to Futures, I see mechanical approaches, like TENS, mentioned. A good sign that their pain treatment is multidisciplinary. Futures doesn’t have an eating disorder program, but they have identified one nearby that they would refer to if that was also a concern.
Pre-approval: be very careful here
Both insurance and programs can happily pre-approve a stay in a treatment program, but they typically only give you a limited number of days, too short for what is needed. This leaves you and the treatment program staff having to fight for more time. Please make sure Futures and Caron talk very specifically about this with you before you decide on a program. Make sure you know the situation and know that the treatment program will fight for you if needed.
Your dedicated efforts to apply CRAFT and help your daughter find recovery are very evident
Chicagomom continues: My daughter had another wish/dip the other day that scared me a little (she asked me to take her dog in the middle of the night and then didn’t answer for about 8 hours). It sounds like she is miserable right now and thinking about treatment but just can’t pull the trigger. I’m contacting Caron to find out what the insurance would cover so I can have that in my pocket. I also looked into the materials you sent about MAT.
I was having trouble with reflective listening and getting her to talk, so I tried to have a normal conversation with her. This is what I was able to find out:
As it turns out, she did like the program at Caron better than Futures and has been reading their website. She asked someone at Futures if they provided MAT and they said no. It sounds like she has done a lot of research on the topic. She’s not too interested in the outpatient options right now.
She was approved by the insurance and is continuing to express a wish to go. But she’s not going, so I guess her motivation is probably up and down all throughout the day. She has a contact she can call at Caron. I’m hoping if she makes that connection, it will make it easier for her to say yes. My next project is to plan how to make the trip there and keep taking advantage of dips and wishes and trying to be patient, even though I know that heroin is dangerous every day. I’ve done all that I can do at this point.
I don’t want to pull the insurance, but it is a comfort to her, knowing that she has it for a few more years, and that may be a factor in her stalling. I’ve been thinking about that. I am going to talk to an attorney as I think the COBRA might be in jeopardy, but I’m not sure. This would change the options, and I’d have to start over in looking for programs, including the Suboxone options.
I found out that she does have some Narcan that her roommate got after her overdose. We looked at Suboxone, but it sounds like with chronic pain it’s probably better to have a real professional involved. She researched it and came to the same conclusion, so that’s on pause. We’re still working towards inpatient for that.
Thanks for keeping us together too. The idea that I was supposed to try to let go with no one to support her getting to recovery was really bothering and depressing me, so I feel a lot better after your help.
Nice work with Caron. A direct number she can call any time is the very best!
Here are a few additional things to consider. After this, I think you will have indeed done all you can for the time being:
• Her roommate should have at least 4 doses of Narcan on hand.
• Call the Suboxone clinic. Learn what you can about the admissions process, cost, wait list, etc. If the place sounds feasible, give the info to your daughter: “Just wanted to get you this info I collected about the clinic near you…”
• I’m still concerned about her overdosing before Caron. I know you are too. I feel like we really need to push the issue of Suboxone to guard against withdrawals and cravings: help with these can be the most motivating message to someone with addiction to opioids. Let’s talk through how you propose Suboxone to your daughter (if you agree to try this now) and what you can find near her that is accessible.
• If she agrees to Caron, what does the transport look like at a moment’s notice? Can you talk to her about having a plan in place?
• Gateway (local clinic in Chicago that provides Suboxone) and Suboxone clinics usually accept Medicaid and non-insured people (at least in Mass, the state is the payor of last resort). All this to say, sometimes more is open to you without insurance in the world of addiction.
• Gateway is a local, lower-bar option if she does not agree to travel to inpatient. They have various options: intensive outpatient treatment (3 hours/day for 5 weeks or so), partial hospitalization (5 weeks or more if needed), or residential with mindfulness sobriety, which sounds like something she might like. Upon admission, they will start Suboxone if evaluation calls for it. Essentially, she is tied to treatment while on Suboxone (which is how Suboxone studies were done). Gateway does not have a specialty in food disorders or chronic pain, but will keep her on Suboxone. They have crisis management for suicidality as well. They know what they’re doing, but it would be wise to visit just to be sure if time permits. They love private insurance.
• So Futures or Caron top your list, with Gateway second perhaps? She can walk into Gateway today and get on Suboxone. I am not making a referral here. I don’t pretend to know what the reality is at any of these places. But I will say that Caron answered my questions promptly. They would leave her on Suboxone if she wants. They would need to refer out for a specialty eating disorder program while she is inpatient with them. Treating chronic pain is front and center on their site.
Thank you for writing in, Chicagomom, and keep up the good work! Please continue to keep us updated on your progress, and don’t hesitate to reach out for additional support.
Chicagomom replies: Would you believe we actually went on vacation? Thank you for responding.
Hi there
I went to the drugstore today to get more Narcan. I know the pharmacist as she is always the one working there and her eyes got very big and nearly starting tearing up when I asked for the Narcan and but she got it for me. I live my life knowing my daughter is on heroin and sort of shutting out the horror of it, but her reaction made me tear up a bit too and I’m longing for her safety and hoping we can get her into treatment soon.
Anyway I have the airlines schedule and rental car all planned and we can get her out of here any day that she wants.
I’ve sent her a suboxone program so at least she has that information. I’ll just keep trying. We get a dip or a wish at least once per week so I hope one of these days it will turn into a yes. Thank you Dominique for all your support and for everything you are doing for everyone on the site.
Just a follow up-she was admitted yesterday to a good program. I’m glad for the help I found here to identify the program and keep me going to get her here. She’s not in good shape at all and it was hard for her (and me) to get here–they let me know that they may need to move her to another facility if she needs acute psychiatric care so I am waiting for another bomb to drop but I’m realizing there is magic power in keeping it “one day at time” and I’m hoping that many of her issues are from too many drugs too much of the time and she will be feeling better with good withdrawal management and some kind people to talk to.
I wanted to send an update that my daughter has graduated into a sober living arrangement. This is a scary transition but she made it down there without any flight cancellations and was able to find a solution when the insurance company denied some of her medications. One day at a time but I’m finding some joy in seeing her personality come out now that she has been sober for a month.