He’s in the Basement & We’re Stuck in a Bad Pattern

HLFrancis is at their wits' end, unsure of how to proceed with an adult son living at home and using opioids. He's refusing to get help.

"I feel like we have hit a wall and are in a cycle that no one knows how to get out of. Our 29-year-old son struggles with substance use. He was introduced to opioids in college and since he graduated, it is apparent that he has co-occurring issues that are also impacting his life. After college (before we knew of his SUD), he was diagnosed with ADD, but I think he actually struggles more with depression and anxiety.

His SUD became apparent to us when he moved home after living with his then GF for almost a year. He has a BS in Business Management, but has been unable to hold even a part-time entry-level job. Whenever he has access to money and/or a car, he spends everything he has on drugs. When he is clean, he expresses hopes and dreams for the future, but struggles with getting help and moving forward. He won't get counseling because he can't see anyone in person right now (during COVID) and would have to meet at the house via Zoom. He feels like we would eavesdrop on his meetings (which is not true). I've explained that because he is an adult, we can't make him do anything, but I will help him and support him along the way. He feels like we are holding him hostage because we won't give him money or transportation. Right now, he is living with us. He sleeps most of the day and watches TV or plays video games most of the night.

He and I had a blow up today. I could see his frustration building – the holidays are the worst, but I didn't expect it to go downhill so fast. I am at my wits' end and I don't know what else to do. Any suggestions on how to move forward would be much appreciated."

Welcome to Allies. Thank you for writing in.

MAT is a first line of defense

The first goal for your family is to engage your son into medication-assisted treatment (MAT). Buprenorphine, for example, can quickly cut your son’s opioid urges; it is a first line of defense as it reduces the risk of overdose death by 50%.

There is a lot to say, but for now consider a one-off talk with your son about MAT treatment, regardless of whether or not he has tried or refused MAT in the past.

How to bring up MAT: the "Planned Conversation"

In preparation for this talk, go to Learning Module 8 and follow our tips for a "planned conversation." Research and write up a detailed list of MAT clinics in your area. Include when to call, how it will be paid for, transportation issues, anything at all that could be a barrier to your son's receiving treatment.

Now keep the list in your pocket, and wait for a moment when your son is upbeat and wants to be clean (read up on recognizing and acting on “a wish,” in Modules 4 and 8 and on the Discussion Blog). Disregard the fact that his good mood is probably because he is high. Forget that this breaks with Module 8 and our point about the need to carefully pick a moment for a planned talk when your Loved One is not visibly using.

I suggest this out of a certain urgency. Your son is using opioids. You don’t know much about his drug use, but you know it involves opioids. My colleagues in the trenches ­— case managers and jail medical staff I work with — tell me that in Western Massachusetts, everything is, or is laced with fentanyl. This means heroin, even cannabis, can be laced with fentanyl, which is so much more potent than heroin. In Western Massachusetts, people are buying heroin and overdosing on fentanyl.

So, please look at Module 8, prepare your MAT clinic list and the conversation with your son.

It might sound something like this:

I love to see you upbeat and hopeful about your future. You make me believe it. I know you believe it in the moment. It gives me hope.

But it doesn’t last, does it. I see you struggling with low moods and anxiety. I know you are using drugs. But I need to have my mind at ease. Consider getting on a medication that stops withdrawals and cravings from the opioids. Here is a list of clinics near us that provide these medications. I’ve called and gotten the details from each of them. I am asking you — for me — to consider getting on MAT. I need to sleep and to stay calm. I am frightened a lot of the time from the danger I see you are in. Thank you for listening to me.

So, no ultimatum. You'll probably get a “NO” in response at first. That’s okay. Thank your son for listening and back away. The goal here is simply to get the MAT list in his hand.

Now: two more things.

If your Loved One is using opioids, get trained to use Naloxone (Narcan) and get all hands on deck

1 — Make sure you (and any other family members who see him often) are trained to use Naloxone (Narcan) and to have it on hand. It is an antidote for opioid overdose. It is critically important that you have at least two doses in the house.

2 — Get all hands on deck and learn CRAFT. By all hands I mean a united family doing CRAFT is better than a splintered family doing a mix of things out of emotion or ideas from popular sources, like tough love. Go to the topic on the right-hand sidebar, called "CRAFT 101." We’ve written a few pieces for new members that lay out the overall framework of CRAFT, and the theory behind it. You could also check out the topic entitled: "Family members doing CRAFT."

So, welcome. You are in the right place. Let’s see if we can address the biggest danger first. Your son needs protection from an opioid overdose. By watching the modules and doing the accompanying exercises, your family will quickly start to make changes that will address the deepening clash in your home.

PS. People with addiction will hold others responsible for their misery, typically those closest to them. In this case, you are it. You are holding your son hostage in the basement. It is your fault he cannot leave the basement because you won’t give him money or a ride. Do your best not to be triggered by this sort of blaming talk. Step aside from these arrows as best you can. Your son is responsible for his choices. You are his family. You love him. So you are dedicating yourselves to learning how best to handle, react to, and move your son towards recovery.

You are partnering with him, and helping him get into treatment. You are not responsible for his substance use, nor his discontent.