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Chicken or the Egg?

pain pills

Alllies member shelleybobelly describes her daughter's coming off suboxone, which eventually led to relapse. Did her daughter perhaps see this coming?

"My daughter recently weaned off of zubsolv. She did this fairly slowly over several months and she didn’t experience too much discomfort so if this is possible to reduce your dosage to the lowest dose it should not be too bad. My daughter did have her wisdom teeth out and during that time she stopped her subs so she could take pains meds. Here is where things got pretty dicey. I did have some medication that helped with the withdrawals. Her sub doctor prescribed two. I also had a prescription for gapapinten. I have also read that taking high doses of Immodium can help. Unfortunately, once my daughter was off the subs she relapsed pretty quickly so please be careful."

This is my opinion, and I may be wrong about your daughter’s motives, but I think it's helpful to hear from an experienced drug user (me).

From your earlier comment, your daughter was doing well on suboxone but had felt rebuffed by members of AA for being on an opioid substitute. According to you, your daughter “did not have a solid footing in her recovery.”

There is a saying in the recovery community: "addiction is cunning, baffling, and powerful." Thoughts of relapse can come on suddenly, or they can brew far back in time, way before the actual use. At some point your daughter was told she needed her wisdom teeth out. With almost total assuredness I will tell you it crossed your daughter’s mind that this could lead to pain pills.

Pain pills were prescribed despite the fact that any good dentist upon being told there is opioid addiction in the mix, would have avoided narcotics, AND considering the fact that there is good evidence that a combination of over-the-counter medication works just as well for this kind of pain.

I see a setup.

This is where having a “solid footing in recovery” could have made a difference. Recovery equals prevention. It means working on your head and those cunning, baffling, and powerful thoughts that repeatedly come up. It means learning from those that have come before, being supported to tell a doctor about your addiction, and asking about alternative medications.

Having been on opioid medications a number of times myself, I can tell you that medications alone do not completely resolve the complex issue of addiction.

For this, you may need therapy, self-help groups, a sober living environment, and healthy living skills. It is a huge undertaking to rework your head from repeated triggers and thoughts of using hundreds of times a day, to living sober. MAT helps lower the biology of cravings, but the mind still needs a radical change.

Did your daughter relapse because she came off suboxone or did she relapse because, without a firm stance in recovery, she orchestrated coming off suboxone to relapse?



In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. I am still trying to figure this CRAFT thing out. My daughter relapsed at the beginning of July and has been in and out of treatment over the last three months. She walked out of her forth rehab last night after being there for three weeks. This has been her pattern all summer. Do a lot of drugs (heroin) get real sick…OD a few times then seek treatment. Recover, get healthy…gain a few pounds and then repeat. The cost this summer have been huge and at what point do you say enough is enough?

    My daughter has been struggling for the past 5 years and she has been to some of the best rehabs in the USA. We have spared no cost to try and help her but I will tell you she has resisted treatment and has just limped through doing the bare minimum. She just doesn’t want to be sober and it is impacting us a great deal. We really want to detach with love and focus on ourselves. We have not heard from her yet but we will eventually. We will get a call from the ER or from her in some jam of some kind.

    I just really don’t know how to approach this in the craft way when we feel she is using rehabs to just regroup and meet new people to go out and use again. I also feel her mental health has not been good but it is hard to tell if it is the drugs or both. For now we are just trying to focus on ourselves but when the call comes we really don’t know how to respond.

    1. Hi Shelleybobelly,

      I can really feel the frustration and a sense of ‘no hope’ in your post. Our family also went through a similar experience with our Loved One (LO). Multiple inpatient rehabs where we started to see improvement and positive change only to have him relapse and reverse all of what we thought was better. A testament to how powerful the disease of Substance Use Disorder (SUD) is.

      Boy can I relate when you say, “…we feel she is using rehabs to just regroup and meet new people to go out and use again.” I felt the same about my son. It wasn’t until I found CRAFT that I started to look at this scenario in a different light. One of the keys to success that CRAFT taught me was to stop focusing on the bad behavior and start focusing on all of the good that he had accomplished. I started to ask myself questions like, “could it be both? Could he really want recovery and to not live this horrible life when he enters a new rehab? Is the craving and need to use just so overpowering that he cannot control himself? How difficult is it to withstand the pull back into that life when he is surrounded by others with the same problems?” It became apparent to me that there were many reasons why my son might be stuck in a rehab>relapse>rehab cycle and maybe his ‘using’ the rehab as a respite might be the positive behavior I should direct my attention to. The relapse part of the disease was what I needed to detach from.

      There were 3 things I would like to share with you that I did to help me feel confident to make changes within me to improve the situation:

      1. I became educated in all things SUD. I did a ton of research, read everything I could get my hands on, enrolled in college classes to help me understand the biology, neurology and psychology behind the disease. I was skeptical of opinion-based information. Doing this helped me to get a better understanding of why my LO behaves the way he does and how difficult it is to overcome the craving for the drug. Just think of going on a diet and having a piece of chocolate cake (or some pastry that you love) on your countertop for the day. In the morning you’re all motivated and commit to not eating the cake. So, to keep your mind off the cake you do the dishes, go for a walk, do some work, whatever activity you can think of to stay away. But, by 12:00 pm you rationalize to yourself, “I will just have a sliver of the cake but no more.” You eat a piece, then hide the cake in a cabinet in the back (as if you do not know it is there) and go back to activities. By 3:00 you convince yourself that it would be best if you just went in and ate the rest of the cake just to get it out of the house. So, you do, and then the guilt and shame set in because you were not able to keep to your commitment to lose weight! I suspect that our LO’s go through this when craving the drug but on a hyper level.

      Getting educated also helped me to separate the disease from the person and not take things so personally. I realized my LO was not doing this ‘to me.’

      2. In my research of SUD, I learned there were multiple pathways to recovery. As with so many things SUD, we find ourselves falling into family patterns and the only solution I have found is to end or remove one part of the cycle. In this case, my husband and I had no control over the relapse of our son, but we did have some say in the rehab options. Early in our journey we had no idea that there were options outside of residential treatment. High priced, comfy plush inpatient rehabs are not the only option and the majority of people do not become sober for life after inpatient treatment. In my son’s case, he seemed to do really well when he was in a very structured environment but it was much harder for him to maintain sobriety the moment he was out. This made sense to me. When in a rehab setting he was bombarded and surrounded by counselors and people in the medical field for a relatively short period of time. 30, 60, 90 days are definitely too short of a time for him to learn new life coping skills or to reach a more manageable level of craving before being released. It took him many years to get into this mess, how could even 90 days of treatment turn it all around?

      One size does not fit all when it comes to SUD and treatment and maybe consider other treatment options for your daughter the next time she is reaching out for help? Here are just a few alternatives:

      Intensive outpatient, counselors, mental health professionals, SMARTRecovery, support groups, MAT, Sober homes, recovery coaches, Refuge Recovery, a sponsor, harm reduction, etc…

      Treatment is about finding what combination of methods will work for each individual.

      This is where I used CRAFT communication and rewards techniques to help my son find what would work for him. When my LO would express he did not want to live like this or that he needed help, my response was to try and meet him where he was at. I would respond with, “I hear you don’t want to live with this anymore. What are you willing to do right now, that I can help you with to get to the path of recovery?” His journey needed to be led by him, not what I thought it should be. I was also focusing on the ‘wish,’ the positive. I intended to reinforce and support positive behavior by engaging but letting him make decisions for himself.

      I also cut off funds to inpatient rehabs. If he wanted inpatient he would have to find a way on his own. This was my way of disengaging with the negative behavior. I was not going to continue to dump my money into a strategy that was just not working.

      Ultimately, my son did not find recovery in inpatient treatment. He found it through a combination of some of the options listed above.

      3. A third thing I did was to take care of myself. In your comment, you repeatedly express a need to focus on yourselves. This is huge! Yes, yes, yes! You absolutely have to take care of yourself. I found that when I was not well, I reacted to the crisis horribly. I was as sick as my LO. When I take care of myself and do some healing is when my response to a crisis is at its best. I have read previous blogs by Dominique Simon-Levine, telling families that when things become too overwhelming, stepping back to take care of yourself is imperative. This is ‘detaching with love.’ It does not mean detaching from the person but detaching from the disease. It also does not mean stepping away forever. Putting yourself first so you can heal and gather strength so when and if you find yourself in crisis again, you will be better prepared to respond. This is the time to really practice, practice, practice CRAFT.

      One last thought. You might want to check out the News & Resources tab then> Resources Supplement then> CRAFT groups and coaches. There is Cathy Taughenbaugh a CRAFT coach and REST groups which offer online video groups that engage in CRAFT based activities. Maybe consider one of these options to help strengthen your CRAFT skills.

      Remember, you are not alone. We are in this together.

      1. Thank you Laurie for taking the time to post. As far as the three suggestions I feel I have done exactly what you suggested.

        1. Educated – I will tell you I have read more books that I can count. We have been doing this now for over 5 years and with each year I feel I have gained more insight into the disease. I listened to your podcast today about relapsing and I found it to be very helpful. I do think I was taking her relapse personal and I really needed to look at that piece again

        2. Treatment- we have done it all, not just residential treatment. You name it we have tried it. The most success we have seen is with MAT and a suboxone treatment base. I was talking to doctor Lee last week and he told me there is now a monthly injection for suboxone. This is something I think would be good for my daughter.

        I am not sure how you prevented your son from residential treatment. My daughter is 21 and she is very treatment savvy so she doesn’t need my help to find treatment. She had a treatment facility in CC send her a plane ticket so she could come. I called my insurance to report it but they told me flat out they could not prevent her from getting treatment there. This is all pretty new to us this treatment brokering and clients getting paid to come but that is what went on all summer. The last place she just left was a place we found. She lasted three weeks and then found a new boyfriend and off she goes. The problem is that she needs detoxing so she will have to be inpatient at some point to get clean so we haven’t found the right mix yet

        3. Self care – yes I realize this is important and I do take the time to do things for myself. As far as a craft coach I had one well over a year ago and Skyped with her weekly. She was helpful but expensive and not covered by my insurance. After several months I felt it had run its course.

        Right now I am going to alanon meetings and listening to a lot of podcasts. The one today talked about a toolbox for when relapses occur. And I liked that suggestion. I have a pretty big group of friends that are supportive but sometimes I feel like I am a burden on them. After five years I am sure they wonder if there will ever be peace in our family and I wonder the same too. The holidays are coming and I am so dreading it. Right now I have no idea where my daughter is and she has not tried to contact us. The thought of Thanksgiving and Christmas coming is about the saddest thing I can think of. Truly I feel like she just might not make it.

        1. Hi Shelleybobelly,

          I have to tell you I am not surprised you are all about the education! Amazing isn’t it? How something like this can change the direction of your life. This may sound a little strange, but in some way, I am grateful for my son’s disease because it forced me to dig deep and reflect on who I am, get educated about something I never would have even given a second thought to, and made connections and bonds with the most incredible people I have ever met in my life.

          Our son also found himself in the patient brokering trap. Really scary and it was hard to get him away from there. Maybe a result of us refusing to pay for inpatient anymore, not sure, but quite possible. When we received phone calls at home I kept the conversation going about how this was dangerous and we weren’t going to fork the money up for it anymore, but let us know when he was willing to try something different. I remember the question I asked him a lot was, “How is this time going to be different than what you have already done?” Eventually, he agreed and came home and detoxed himself (I would never recommend detoxing outside of a medical facility). It was actually him telling me he could not recover where he was (On the streets of Florida).

          If you have a moment, take a look at the REST video conference meetings. They are free, CRAFT based, and use the Allies in Recovery website. I did some video conference meetings a couple of years ago and they turned out to be great.

          My son also is on Suboxone as a part of treatment plan. He has done well with it and will probably have to stay on it for life. Whatever it takes for him to live a happy healthier life!

          I hear you about the holidays. I feel like I am on edge every year during that time. It is stressful for us and for our LOs. I live in the northeast so Seasonal Affect Disorder seems to be a contributor too.

          I can tell you this, you are not a burden here. It is great that you post your questions and concerns. Just think of all the people that are reading what you post that have the same thoughts and don’t know where to turn. Others are going to benefit from your reaching out and sharing your struggles. I can also assure you that everyone here at Allies in Recovery care about what you are going through. Personally, I believe this is the most difficult disease to be faced with, not only for the individual but for the loving family surrounding them.

          Again, I feel the sense of hopelessness when you say, “The holidays are coming and I am so dreading it. Right now I have no idea where my daughter is and she has not tried to contact us. The thought of Thanksgiving and Christmas coming is about the saddest thing I can think of. Truly I feel like she just might not make it.” I wish I could reach through the computer and give you hug. I wish I could reassure you of all things that might not happen. Just know that many of us have or had these exact fears and worries. You are not alone. We are with you.

          Keep posting. What you have to share is important!

  2. I recently reread this post and was struck by shelleybobelly’s final paragraph.

    “I don’t know anyone who can watch a horrific accident and not be impacted by it. In a way this is what CRAFT is wanting us to do and I just don’t have that skill level.”

    How did I miss the pain expressed here? In our focus on the addict we often forget about the loved ones and their journey. I too have watched with horror and live with the scars of memories I can’t erase. Of course you can’t look away and save yourself. I know I didn’t want to. I wanted to save my son, not myself. I not only didn’t have the skill level to be able to do that, I didn’t want that ability.

    I can’t speak for the CRAFT position on this. I can only offer my experience. As a parent of an addict in recovery, I have a form of PTSD more similar to an abusive relationship than the kind that results from witnessing impersonal violence such as an accident. This is a loved one who has hurt me over and over again. It has helped me to deal with it by stepping back in the moment and acknowledging my feelings. My racing thoughts, beating heart, churning gut. I can only connect with my son if I am calm enough myself.

    Getting more control over my emotions is self care that doesn’t ask me to abandon my loved one to save myself. It is work and I get better with practice. I have cultivated lots of support to do this, support groups, therapy, meditation, this site, etc.. Patience and compassion. For myself as much as for my dear one.

    Sharing helps too. It encourages reflection and vulnerability and dissolves shame. We are not alone. Besides, it may help someone else. I highly recommended it to those of us with this kind of PTSD. Thanks for providing this space to do that.

    1. Thank you Momdog. I have written elsewhere about the effects of addiction on the family and PTSD. The shocks, crises, worry, and pain, compounded over years, are often poorly understood by those not experiencing it. It makes me emotional just reading your comment.

    2. I, too, am quite moved by your comment, Momdog. You write eloquently about the family’s experience—which reminds me that in addition to all of the great ideas you include in your comment, writing in itself can be (studies have shown this again and again!) therapeutic in itself. I’m thrilled that Allies in Recovery has been one of your supports in pursuing your own recovery. Thanks, too, for sharing what you’ve learned-felt-experienced for the benefit of us all.

  3. I just want to clarify a few things that I guess were confusing about my post. My daughter had three wisdom teeth taken out at the beginning of May. I did talk with the dentist extensively about pain management and even suggested only doing the one tooth that was impacted. He felt that the pain could be managed with over the counter meds and he had other patients that did well. My daughter did attempt this but by the third day her pain was significant and I did ask dentist for pain meds that my daughter took very sparingly. I do agree though that this event did impact her and was probably the first sign of trouble ahead.

    After this my daughter got back on her subs and started her new job at the drug rehab place. She did after decide to start weaning off her subs very slowly and by mid June she was totally off. It was when she had her 21st birthday that she relapsed at the beginning of July.

    I do think the MAT helped my daughter reach a level of functioning that she was not able to reach previously. I know it is not something to be done on a long term basis but for some addicts it is life saving. Since relapsing July 2 my daughter has been to three treatment centers. These are places she has found herself and it has not been a good experience. She OD’d two weeks ago and right now I am pretty surprised she is even alive.

    It is hard to try to keep the communication lines open when you have a homeless child that sold their phone for money for drugs. I do try to see the positive in every situation but at times it is extremely hard to do so. We now have the aded problem of her boyfriend she met in treatment. He seems to be controlling her and making it difficult by isolating her and providing her with drugs.

    There are just so many really horrible situations and for our own sanity we need to step back and save ourselves. There is nothing like getting a call from the ER from your child telling you she died but won’t tell you what hospital she is at. Ultimately it is her life and she can do what she pleases but it is like watching a car crash and not be able to help. I don’t know anyone that can watch a horrific accident and not be impacted by it. In a way this is what CRAFT is wanting us to do and I just don’t have that skill level.

  4. I noticed some things that would have been difficult to me, in the realm of relapse prevention, I would call them “set ups” for relapse.
    –First, the mention of wisdom teeth (plural) – were all extracted at once? That can be more overwhelming than just taking the 1 or 2 most troublesome ones out first, waiting for healing, and continuing the treatment plan.
    –Second, buprenorphine (with or without naloxone in the mix), has been used very successfully by itself for pain management. That’s what the drug entered the market as way back before ever being thought of as MAT. I think that a consultation between an expert prescriber for MAT and a knowledgeable dentist or oral surgeon might result in dialogue of adding an appropriately dosed and timed ibuprofen-acetaminophen combo, and also increasing the MAT dosage for the period needed to get the patient through the post-op discomfort if needed. Buprenorpine is a partial agonist, but has tremendous affinity (sticking tendency) for certain opioid receptors–most notable ones for pain and craving, that is shared by few other opioid drugs, so the overt or covert cravings may be tremendous during such a taper. A person used to a steady state BUP level would likely NOT get the constant state of receptor satiation on small dentist-prescribed amounts of a full-agonist opioid like oxycodone or hydrocodone every 4 hours, even if the tolerance were taken into account, AND these drugs in high amounts definitely place the person at a higher fatality risk. They also are more readily abusable by the IV route.
    –Third-HIGH DOSE IMMODIUM IS A VERY BAD IDEA!!! THE RESULTS HAVE BEEN FATAL IN SOME CASES, AND HAVE LEFT OTHERS WITH SERIOUS DEPENDENCY ON THE IMMODIUM ITSELF! These fortunately are not common experiences, but I have noted that lately places like WalMart feel the need to start distributing 104-count bottles of the stuff in my area, and it seems to be flying off the shelf. There may be more than 1 reason for that. It is an opioid-agonist, but in doses for diarrhea will not appreciably cross the blood brain barrier. In mega-doses it can, and some people can’t get enough. There is a serious risk of “Toxic Megacolon” (not a dinosaur) and associated problems & damage with this method of use as well.
    –4th, and Finally- we’re all expert when it comes to insight into the behaviors of the people we read of in blogs. I’m not sure what your daughter would even say or believe about the course of events and decisions that led her to this point. I’ve had one or two similar experiences and in the aftermath people asked what I was thinking prior to taking these actions, to which I honestly replied, “Thinking???!!? You mean I was?” The only thought seemed to come after, while standing over more wreckage, shame and guilt and thinking, “what the hell happened this time??!!??” This is where a therapist, mentor, fellow in recovery, sponsor, etc might help. Certainly people have recovered from addiction MILLENIA prior to the arrangement of AA’s 12 Step methods or any therapeutic profession.
    In my own addiction, I have come to believe that the combination of all these works best for me, and mindfulness is key. I believe that when I’m actively using, the part of my brain that registers pain relief is the same that registers pleasure or those things that are needed for survival at an instinctive level, WAY before the process goes logical-analytical or into any delayed discounting process. I won’t battle danger or run from it, even when I should (fight-flight), I won’t eat or drink (feed), and even my sex drive is replaced by the drug (reproductive drive)–these are basal for the survival of our species, and they are the first to go from the mid-brain we share with lower creatures like snakes, fish, etc.
    Loved ones tend to see and be hurt more by the creative, higher reasoning part of the brain that’s responsible for formulating resentment, manipulative behavior, and everything else that looks evil. I thank you and everyone else who shared and my best to you family in hopes of complete forgiveness and healing!

  5. In reading through this discussion, I am reminded of an article I read some time back in “Addiction Professional” magazine, that in my opinion did a thorough job of describing how complex the treatment is, and how we often search for “magic bullets” in the form of various MAT protocols as panaceas. I attach the link to the original article, and would urge a close reading, and I believe it offers some valuable insight into just how we need to re-evaluate the treatment of addiction. I quote a small part of the larger article:

    “MAT is spoken of today almost as a holy grail for addiction treatment. This is not because it restores a normal brain, but rather because it is affordable and expedient and provides relief just like a bypass for vascular disease. Yes, we should use these things. They decrease loss of life and complications. They are only Band-Aids, though, for the underlying disease process. We must not be lulled into believing that these medicines are the answer. Addiction is far too complex.”