He’s On Meth but Doesn’t Want Treatment

jl5549's son has started using meth again despite having now begun therapy. The modules have provided good guidance but mom has questions about how to approach this new bout of using — should she wait a while to see if the therapy helps, or if he exhibits 'change talk', or should she be even more proactive?
 

"Hello, thank you for your assistance. Your CRAFT modules provide guidance and support, thank you.

I am not sure what to do. My son (20's) is struggling with substance use (meth). He has been in the hospital but not treatment. Two years ago he went through court ordered treatment for marijuana. So now he says he's against treatment. He started seeing a psych. therapist for depression. He did not use for about 3 weeks after released from the hospital. But now he is again. He doesn't realize that I know. I am using the techniques from CRAFT with him for any conversations we do have. I am keeping positive with him. But he IS using. He sometimes doesn't come home for a few days, then maybe just for a few hours for laundry. He has dropped out of college, but works full time at a restaurant. The counseling is just starting, two sessions in, so do I give it more time before changing anything? Do I continue to give positive reinforcement to foster lower use? I am confused if I should keep the living arrangement as it is and look for wishes or dips, or push for something else. Also, is there hope for a recovery for him since it is meth? Thank you in advance for your guidance."

People absolutely do recover from meth

Methamphetamine is a challenging drug to recover from but people absolutely do recover and go on to live healthy lives. You have but to look at David Sheff’s son to see the influence one former “meth head” can have, and to be in awe by how far Nick has come. Nick and his father’s writings have touched so many people in similar circumstances.

Here is a good article on the use of, and withdrawal from, methamphetamine.

Depression with meth withdrawal is achingly slow to lift

Your son is struggling and is being treated for depression. This isn't surprising because depressed feelings accompany most (all?) drug withdrawals. The difference with meth is that the depression lifts so achingly slowly that it's barely noticeable.

And the thing with depression is that it carries with it a unique, dominant belief: that is, the strong belief that things are hopeless.

William Styron, who wrote Sophie’s Choice, suffered from debilitating depression that came on when he quit alcohol in his 50's. The New York Times calls the author of Darkness Visible "the Great God of Depression." In his "memoir of madness", he describes something unique to depression, in that with depression, the mind sees no end. Styron talks about being in Paris to accept a prize and seriously considering stepping off the curb into the traffic on the way to the ceremony.

In his now-famous NYT Op-Ed, where he outs himself as mentally ill, he describes one particular bout of depression with these words: "my nights were without sleep and my days were pervaded with a gray drizzle of unrelenting horror. This horror is virtually indescribable since it bears no relation to normal experience."

Styron points out how with most any other condition, whether physical or mental, a sort of survival system kicks up and reminds us to hang on, this too shall pass. But not with depression.

I was recently reminded of this while speaking to a friend who is dying in the hospital of terminal cancer. I was amazed at her clarity; she knows she is dying and she's accepting of it, resigned too, but also accepting of it. Yet, still sprinkled throughout our talk were anecdotes of people who had their cancer cured, despite all odds. She looked forward to going home. I think we both knew she wasn’t going home. These were amazing moments of hopefulness despite all odds… spontaneous thoughts that simply don't strike you when you’re depressed.

With meth withdrawal also comes anxiety

As the weeks go on, recovering from methamphetamines is also hampered by increasing levels of anxiety. Your body is weak, yet your mind makes your body jittery, so you have trouble sitting or lying still. You are overwhelmingly sad, AND the internal messaging continues: NONE of this WILL EVER LIFT!

Completely absent are those tiny, spontaneous, hopeful thoughts that the pain and discomfort will end.

How long would any of us last? How long would any of us last if finding the dealer could end all this pain in an hour? (Hope just got a jolt … even just the thought feels good.)

Treatment options

Your son is talking to a counselor. It’s very new to him. Somehow, a counselor for depression is outside the realm of “treatment” in his book. You have found a way in. Well done.

Your son’s counseling could include an evaluation to see if medication could help. There's some evidence of the opioid blocker Naltrexone being effective (see this post in our What's News Blog). Cognitive behavior therapy is a widely studied form of talk therapy useful for both depression and drug use (see our page on CBT in the Resource Supplement and this page on treatment for Stimulant Use Disorder, which also highlights a promising approach called Contingency Management).

Safety is a real concern when meth is in the mix

If you click on methamphetamines in our list of topics on this blog, you'll read about other families on this site dealing with meth addiction. One of the posts focuses on our concern for the family member’s safety when meth is in the mix. In this piece we evoke the possibility that a Loved One can become violent, even when there is no prior history of violence. Also, see this post: I Think I'm Ready to Ask Him to Leave.

Your son's recent hospitalization, short period of abstinence, and his current use of meth — a drug believed to provoke violence —all signal to me the need for a program that is residential, long-term, and designed for Stimulant Use Disorder.

But does that even exist? One thing is for sure, you cannot be it. You are neither trained, nor equipped, to provide the specialized environment for your son. Rather, CRAFT would prefer you put your energies into shepherding him through the door of that specialized care.

A plan of action

Step 1. Revisit the Safety Module.

Step 2. Locate or cobble together the closest programming anywhere in the US that is residential, long-term, and designed for Meth / Stimulant Use Disorder. Don’t get discouraged with this. It may not be possible to find much. Can you afford private care? Private care opens the possibility of dude ranches or cool urban group programs in the heart of big cities. Write it down on paper and prepare a draft of a text (whatever will be easiest for your son to return to it).

Step 3. Focus on the communication skills taught in Module 4. Connecting with your son through communication will keep that bridge between you solid. It is this bridge that he will eventually cross when he's ready to say, "Mom, I’m tired. Let’s look at that list of yours."

Step 4. Present your son the list in a formal talk. Module 8 gives you a how-to. Keep it small and short.

Timing: after a good dinner?

I just want you to have this. It’s a list of places that can help with meth addiction. I put it together for when you might want help. I’m going to put it on the side of the fridge (if that’s okay), and send it to you in a text. (Avoid the word 'treatment' at all cost).

and/or

I’m scared. You're using meth again occasionally. I'm getting help for myself so that I can manage my own stuff around this. They suggested I work on a list of options for you. If and when you need more help, here's the list. Know that I love you, and I'm not going anywhere. Thanks for listening to me.

Step 5. Right now, your son is living at home and working in a restaurant full-time. He occasionally takes off for a couple days. Would you agree that these are the days he's using meth?

When he is home, is he abstinent? More or less?

Remember the central question we ask you to ask yourself whenever you see your son (Module 5):  Is he using right now or not?

For now, let’s just go on the assumption that:

When he comes home from being gone for days, he is withdrawing from a meth binge.

Apply Module 6: My LO Is Using, Now What: disengage, remove rewards, and allow natural consequences.

Once the worst of the symptoms subside and he starts to return to:

Being home, sleeping at home, and going to work as scheduled, we’ll call this the period of:  he is not using meth.

Then you'll apply Module 5: My LO Is Not Using, Now What: Reward. For you, this might mean being light, cheery, staying off hard topics, and generally turning up the family warmth.

See what resonates for you in Modules 3 — 6 and practice for 4 – 6 weeks before you try to engage your son into treatment (Module 8). Make that list of treatment options early in a small formal meeting in which you present the treatment list (step 4), in case your son surprises you by mentioning a desire to stop his drug use or expresses wanting help.

Remember that 70% of families get a Loved One into treatment within 12 weeks. You are laying down a plan based on what you can do, the actions you can take. Keep us posted. We would like to know of programs that address meth addiction. Are there other family members that can help?