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.