He is Relapsing Right Now, Should He Leave Home?
Is.54:10 is confused and discouraged, and wary of being manipulated by her son who has begun using again and is still at home.
"Dear AIR Team, My adult son has SUD. He has been abusing opiates for many years. He now lives at home, with the understanding that he must stay in some sort of treatment program and not be actively using. 6 months ago he had a relapse. At that time, he willingly gave up his keys and took his car off the road (this was his idea, he said he didn't trust himself to drive). For months we drove him to work, appointments with his counselor, and to the suboxone clinic, as he is on a MAT plan. Per our request, he reached out to a recovery coach as well. He seemed to be doing quite well, and we were so hopeful that he had turned a corner. During this time he saved up enough money to purchase and insure a nice, used truck for work. We felt that he was ready to start driving again. I guess we were wrong, because he has used again, at least three times in a three-week period. He stayed out all night on two different occasions. My husband is fed up and thinks its time to ask him to leave, but I'm not so sure. My son is going back to counseling tomorrow, and says he is willing to do whatever it takes to succeed. He says he doesn't want to go backwards and doesn't want to let us down. Are we being manipulated? Are we enabling him by letting him stay? I'm not sure that he is willing to do the hard work necessary for long-term recovery, although he says he is. I want to believe that he is sincere and truly desires something better. Any advice? We are so confused and discouraged, we could use a fresh perspective."
Dear Is. 54:10
Your son is living at home and has relapsed. You and your husband are divided on whether to ask him to leave.
Thank you for writing in. This is a core issue for families, one that we have written about several times before (see topic on blog sidebar = home as a reward).
Your son used opiates several times after months of being abstinent. He says he will do everything to succeed but you have your doubts. What you may be feeling is his ambiguity: I want to use, I did use, but I don’t want to use, I want to succeed. Ambiguity resides in all of us when faced with change. It is part of the change process. If, as family members, we wait around for a 100% commitment from our Loved One, we will almost certainly be waiting a long time. Family members must make decisions and take actions in an environment of probabilities.
David Sheff, author of Beautiful Boy, put it like this: “A world of contradictions, wherein everything is gray and almost nothing is black and white.”
Your son is on MAT, is still talking to a recovery coach (?), sees a therapist, and says he wants to try again.
The truck was purchased with money he earned, I assume, so maybe he has a job. He knew that driving was a trigger and asked you to take his keys. After months of being ferried around, he thought he could drive again and this freedom—to some degree—caused a relapse.
A structured, safe environment such as you provide your son, with taxi service to appointments, has no doubt helped him get some footing. Stepping out of that closed, protective space may have caused the problem. But he has to step out at some point, and there are all sorts of perilous things in the greater world. It is a learning process with feedback for him.
He’s back on his feet and promising to do better. Go back in time in your son’s life and you will probably see a series of trials and errors, promises to stop (either to you or to himself), followed by starting to use again. See this post for a graphic representation of the elliptical process of recovery. It is less the turning of a corner than a slow, curvy road that eventually straightens out.
I see a lot of willingness on the part of your son. He is doing more than most to fight a crushing addiction. Look at his actions: MAT, giving up his keys, recovery coach, therapist.
And what about you and your husband? What can you both tolerate? Can you agree to having him stay in your home if you make things a little more temporary? We've written about a bed in some common space with a foot locker for his things. Alternatively, is there a safe place he can go live? Maybe this is just too hard on you both and your son needs a sober house. This is also about what you can both accept going forward.
Along with the restricted space in your home, can your son agree to add more into his recovery plan? Seems like self-help is a hole. We provide a list of options in the Resource Supplement. What will it take for him to get into that truck and drive to a self-help meeting rather than to the dealer?
CRAFT suggests small steps, and this applies to both you and your son. Your son has relapsed. There must be natural consequences… His living situation just got a little tenuous. He is now in the den. He is now being asked not to come home when he is high, being welcomed back when he is not. He now has to check out various self-help options in the area.
If you and your husband can do this, it may be the right level of consequence. The aim is of course to let him feel the discomfort of the natural consequence, while being careful not to squash his motivation to jump back into recovery.
I have a question about substance abuse and mental illness. My son is an alcoholic and is in psychosis. He has been this way for a number of years and has been to numerous programs and is always back in the house almost immediately. I am told kicking him out in any way would be unethical and immoral. His psychosis and substance abuse issues are completely co-mingled. Would you have any advice on the mentally ill and substance abuse?
The presence of mental illness along with addiction is the rule rather than the exception, with the greater percentage of addicts showing some form of mental illness, and patients that present a mental illness first often self-medicate which can easily lead to addiction.
Most substance abuse treatment facilities are therefore now “Dual Diagnosis” or “Co-Axial Diagnosis” facilities and should be able to treat both of your son’s problems at the same time.
But treating both axes of diagnosis, both addiction disorder and some form of psychosis at the same time, can get complex because the substances commonly used to treat the psychosis can themselves be very addictive and extraordinarily dangerous in combination with alcohol should he relapse.
There’s some information that’s missing, however. Why does your son continually get discharged early from these programs? Is he uncooperative or is he violent? Most programs will not keep a client if they simply ask to be let out, unless there is court involvement. Would an IOP (daily program) be a better fit for your son?
I also do not understand your sentence, “I am told kicking him out in any way would be unethical and immoral.” Ethics refer to professional standards, not the relationship between a mother and her adult son.
Saying something is “immoral” where addiction is concerned raises my eyebrows to the roof. Some people would have you believe that medically assisted treatment of methadone or Suboxone is “immoral” for opioid addicts, but because of the soul-crushing deathrate of the opioid epidemic, I would certainly choose that gray over the black of death.
But for you then, what to do? And what is the moral choice? I can’t say. I can’t speak to your morality, but I can speak as a substance abuse professional. If your adult son’s dual problems present a danger to you in your home, then it’s not safe for you, nor is it safe for him either.
As the respondent (Zildjean2000) already mentioned, the rates of co-morbidity of both substance use disorder and mental illness are very high. When you say psychosis, it suggests to me that your son perhaps has a serious mental illness, the definition of which has evolved, but that basically includes disorders that produce psychotic symptoms, such as schizophrenia and schizoaffective disorder, and severe forms of other disorders, such as major depression and bipolar disorder (www.bhevolution.org/public/severe_mental_illness.page).
These disorders can definitely complicate treatment and recovery. In an ideal situation, your son would be treated in an integrated program with an integrated team (psychiatrist, psychologist, substance abuse therapist—or some derivative of these three roles—along with a case manager/social worker to help with aftercare planning). Team members would meet regularly to go over your son’s care and progress.
The reality, however, is that this rarely happens……Read Dominique Simon-Levine’s full response here: https://alliesinrecovery.net/discussion_blog-serious-mental-illness-addiction-help
I’m reaching out again because despite what he says about being committed to recovery, and despite going back to his out-patient treatment, my son’s drug use seems to be increasing. Instead of going to work today, he went to get high. As I’m writing to you, he’s still hanging out with the “friends” that he uses with. If he even comes home tonight, I plan on sending him away for the night. I’m so unsure of what to do. We know where he is, should we step in, or just let it be until he shows up? I would like to try to apply CRAFT to our situation but I’m scared for him. We are heart broken but just trying to keep our heads on straight.
Is. 54:10
Hello IS 54:10. We’ve prepared a response to your question and will be posting it momentarily. In the meantime, I will send it to your email. Dominique
Your son is living at home and has relapsed. You and your husband are divided on whether to ask him to leave.
Thank you for writing in. This is a core issue for families, one that we have written about several times before (see topic on blog sidebar = home as a reward).
Your son used opiates several times after months of being abstinent. He says he will do everything to succeed but you have your doubts. What you may be feeling is his ambiguity: I want to use, I did use, but I don’t want to use, I want to succeed. Ambiguity resides in all of us when faced with change. It is part of the change process. If, as family members, we wait around for a 100% commitment from our Loved One, we will almost certainly be waiting a long time. Family members must make decisions and take actions in an environment of probabilities.
Read Dominique Simon-Levine’s full response to Is.54:10 here: https://alliesinrecovery.net/discussion_blog-he-is-relapsing-right-now-should-he-leave-home