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She Begged to Leave Treatment

Lifeguard at Lake

Fireweed3 seeks clarity on using CRAFT while her Loved One is in treatment, begging to be picked up. There are so many scenarios that could play out if she holds firm and doesn’t pick her up. Maintaining trust in their relationship is so important – how does CRAFT apply in this situation?

In the post titled "i don't want to threaten him — but so much is at stake" you touch on the tough love approach when you refer to ultimatums.

At one point, you state: "The confrontation and defensiveness you describe are all too familiar to the families on this site – and beyond. This is one of the reasons why we urge family members to be cautious about delivering ultimatums without an individualized consideration of the big picture."

I was faced with an ultimatum situation recently. I wasn't sure how to navigate it in a CRAFTy way. It worked out well, but I still want your input on it.

My 20 yo daughter was released from 2-day detox (too soon) and went to treatment. She coordinated the treatment on her own. The facility is out of state, 3 hours from our home. Because she was still detoxing from various substances including benzos, she started having panic attacks shortly after arriving. The following day, she was threatening to leave AMA. The unfamiliar environment was triggering her trauma as well. Between sobs, she begged me to pick her up.

I was advised by treatment staff to hold boundaries and refuse to pick her up. While I understand the reasoning, it was a response that didn't align with my values — love, connection, trust, self-determination, etc. I was concerned about several scenarios:
1. I refuse to pick her up; she leaves AMA; and has no cell phone or cash in the Seattle area
2. She approaches a stranger to borrow a cell phone to call her boyfriend, a Seattleite with connections (not all of them positive)
3. She loses trust in me as an ally

I opted to talk calmly with her, validate her feelings, and remind her of what she shared the day before — feelings of shame, paralysis, unable to attend school or work like her "normal friends" etc. I also told her I had been thinking of ways to acknowledge her efforts to coordinate treatment with "something special." I even mentioned those Doc Marten boots she's been wanting. At this point, her case manager stepped back into the call. He offered to talk to her some more, and get back to me. When he called back a few hours later, he said she agreed to stay through the weekend. During that window, she started to gain clarity. She wrote me a letter, thanking me for not picking her up. She says she's committed to completing 30 days.

I'm curious what you think through a CRAFT lens.
— Would picking her up have been appropriate, as a way to maintain a trusting/supportive relationship? I need her to trust me when I help her access treatment next time. I thought perhaps I could pick her up as long as she agreed to access services locally after fully detoxing.
— Picking her up would be considered enabling in the traditional sense. Similarly, it would not be enabling in a CRAFTy way (supporting behavior conducive to treatment/recovery).
— Or, could leaving her there be within the CRAFT model, as long as it was offset it with a reward for "sticking it out?" I did not want her to come home yet, but I also did not want to leave her there against her wishes — to me, that would have been detrimental to trust. Was also concerned about her leaving AMA to connect with boyfriend's contacts.

Tricky! Maybe I'm overthinking.

Thank you for sharing this update with us. You ask an important question. And you offer a glimpse into the head of a family member wrestling with concerns about a Loved One who is thinking of leaving treatment.

I think it is important to realize that two, four, even five days of detox from various drugs doesn’t leave you “well.” The role of a detox is to protect the person from the harm of withdrawals. Once that person is medically safe, they are discharged.

After that, the person is back on the street, exhausted from detoxing. They are neither over the psychological nor the physical effects of this upheaval to their system. When I tried to detox in a hospital from methadone I didn’t sleep for weeks. I would pass out occasionally out of exhaustion, but there was no regular restful sleep. This quickly breaks someone struggling with depression.

Your poor daughter. She got herself to a treatment center, amazing! And she instantly wanted to leave… I get it.

Your daughter is in a safe place where she can continue to detox and move beyond this terrible time. The treatment program asked that you not come get her.

I can’t tell you how many times over the years I have heard some variation of this story. The details may change, but one thing remains the same: the LO wants out.

Let’s keep in mind that 50% of people who know they have a substance issue refuse help. Treatment is still the best answer we have for dealing with the addiction of a Loved One.

Your daughter is in treatment which means you are substantially ahead of the game. Hurray!!! CRAFT pushes treatment: this is its fundamental goal. Getting into treatment was the main outcome in all the NIH studies.

As a mom, you must have felt terrible hearing your daughter beg to please come get her. CRAFT would have you support her in treatment, to give her a fighting chance.

Maintaining a trusting/supportive relationship is how you get her into treatment; it’s also how you keep her in treatment. I don’t think you lose this trust by ignoring her request to bail. But how you respond can reinforce your love and support even in this new context:

“Hang in there darling, every day from this point forward will leave you feeling a little better. You are doing the very hard work at this moment. I am so relieved you are in treatment. I’m sorry this is so hard. I am here and I’m not going anywhere. Please hang on. I’ll check in tomorrow.”

While your daughter is in treatment, CRAFT means using supportive language to help her stay in treatment. It means coming up with next steps with her and her counselor. And it means providing emotional and material support for the current treatment, as well as for what comes next (the next step down from inpatient treatment).

I understand your emotions. Your daughter is miserable and has requested your help to get her out of treatment. It can indeed leave you emotionally confused and distraught. And  you are right to consider this carefully. I appreciate the question, and I’m sure others here can relate to your thinking.

Helping a Loved One hang on through those initial hours and days of treatment is in alignment with the overarching goal of CRAFT. Don’t let go of this underlying logic. It sounds like you did an incredible job of hearing and validating her, while at the same time not "giving in.” Your relationship and trust remained intact; she was able to stay where she needed to be.

We can expect a wide range of behaviors when a Loved One enters treatment. Through this time it’s important to hang on to ourselves in order to step out of the way, so to speak, and give them a chance to actually receive that treatment. Having gotten a Loved One this far, your role is to operate at more of a distance, whether the facility is down the street or in another state. How you maintain communications will be different depending on your relationship. You’re not out of the picture, but you’re in the background. Now it’s their time to begin the work that is only theirs to do. And this frees up some space for you to embrace more self-care as and find your center again.

To honor the connection and trust that you’ve cultivated, you can focus on offering responses to her pleas that are still loving and compassionate. You can practice this even as you hold your position about staying in treatment. We have noted that consistency is so important in practicing CRAFT in the day-to-day. So at this juncture, we remain consistent in our message about sticking with treatment.

It’s a tricky time indeed. You have seen your daughter through a significant transition. Thank you for sharing this with us, and for handling these challenges with such strength, love and grace. It’s heartening to hear this, and it’s fantastic to know that your daughter is getting – and accepting – the help she needs. Bravo!



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. My 20 yo daughter is in active addiction again (heroin, oxys, stimulants). She relapsed after completing treatment out-of-state this fall/winter. I was especially hopeful this time as she had entered sober living, away from home and all its triggers.

    When she returned in January, she tried to reconnect with SUD IOP and meetings. But she also started spending time with a young man who has been using IV heroin for several years. She thought she could help him; but instead of him leaning into her world, she fell hard into his. Soon there were familiar behavior patterns, positive UAs, and paraphernalia in her living space (boxes of syringes, tie offs, alcohol wipes, metal bowls, etc.). I tossed everything, cleaned the space, and carefully/lovingly packed her belongings in boxes. Then I texted her to express sadness that the ADU on my property wasn’t yet supporting recovery, despite several attempts.

    She decided to “get back on track.” Upon discharging from detox — inducted on Suboxone — we met over coffee and pastries and discussed a post-detox plan. I had 3 requests:
    1. Attend DBT eating d/o IOP* — this would be her “job and school” for 3 months
    2. During DBT, get quality sleep at home — no overnight guests, no overnights at boyfriend’s
    3. Connect with the recovery community in whatever way is meaningful to her

    She agreed. But she couldn’t set boundaries around the relationship. She continued to spend time at boyfriend’s house — sneaking out in the middle of the night, not waking in time for DBT. She also opted to get a job at a cafe, instead of prioritizing her DBT program. (Boyfriend doesn’t work; they have no money.) And she failed another UA.

    I provide this context because she is expressing a desire to move back home and get detox/MAT again. She is growing tired of living at boyfriend’s house, and is worried about how she’ll manage a shift at the cafe when she’s using and/or dopesick. (She has been struggling to manage during training sessions.)

    In short, I don’t know how she can sustain recovery as long as she’s in this relationship. CRAFT says not to focus on a loved one’s partner — it drives a wedge, and ultimately causes the LO to defend the partner/relationship. But it’s difficult to imagine how she can move forward when she’s intimately involved with someone who is using.

    Notably, she’s using pressed pills (fake Oxys) now too — the same ones that have fentanyl in them. There is a sense of urgency for her to get treatment, and I want to help her. MAT could be life-saving, if she can stay with it this time. But as stated above, I can’t quite envision this while she continues to see boyfriend. He uses daily to stave off severe w/d, and has no plans to make changes. Not yet anyway.

    I need some guidance.

    If she asks me for help to access detox/MAT, do I allow her to move back home with the same post-detox plan as before? Or is there something I can/should add to it? Or do I suggest sober living? (I can’t afford sober living, cost is a barrier. I raised one month’s rent via Go Fund Me last time. Regardless, with COVID-19, it doesn’t seem to be a good option.)

    Do I encourage her to keep the job at cafe, versus asking her to do DBT eating d/o program right now? She desperately wants help w/ eating d/o, but having a job may be helpful in other ways. She and boyfriend are very isolated; she rarely sees people who are not using (or otherwise struggling).

    Outside of motivational interviewing, is there a CRAFTy way to address the elephant in the room (boyfriend who uses)? I realize I cannot tell her to stop seeing him.

    As a single parent, I do not have unlimited resources for frequent trips to detox and rehab. Nor do I feel it’s helpful to fall into these patterns with her. I need to make some adjustments this time around — just not sure what/how.

    Thank you as always.

    * Eating disorder is a root cause of addiction, along with estrangement with father