He’s On Methadone and Frequently Relapsing with Alcohol
Lucy@2018’s Loved One started with alcohol and moved on to opiates. He’s been using since he was a teen, through countless programs and relapses. He’s currently on methadone – though he relapses frequently with alcohol. She thinks he’s burnt out on AA and also wonders about transitioning him to suboxone.
My son's drug of choice was always alcohol beginning in his teens and he is now 33. After many relapses, rehabs, IOP's and bad sober homes, we had detached because he was using and we were waiting for him to contact us when he was ready. When he called we found out he was snorting heroin and had elected OP methadone. He did well for13 mos and then relapsed turning to injecting heroin. He has stopped injecting since Jan but is relapsing frequently on alcohol and continues on daily methadone 50 mg. Currently in detox and considering his next move. We are all interested in programs at BMC. How to get started? He has burnt out on AA but seems like he could use a sober coach or sponsor. I think he needs a good evaluation for depression and management of his anxiety, and has used vivatrol, campral in past. How soon can he get on suboxone? He says he's afraid to give up methadone because if he is abstinent he could die if he slips up.
Dear Lucy: Your son is in a detox for alcohol and opioids. He is on a maintenance dose of methadone.
Your son is correct to be worried about “slip ups” with opioids and overdose. Half the overdose deaths now are due in part to fentanyl in the mix. People selling drugs are mixing in fentanyl. A tiny amount is all that is needed to make a drug (cocaine, heroin, even street cannabis) much stronger.
People don’t know what they are buying. It is truly dangerous out there.
The methadone clinic should be helping your son find a methadone dose that helps him stop all cravings for opioids. I would start here. Forget coming off methadone for now. Your son should be talking to the clinic about raising the dose to one that takes away all urges.
Suboxone can be a long-term plan, once your son is stable on a methadone dose that keeps him from using. He would titrate the methadone dose slowly with the help of the methadone clinic to a dose of methadone that allows him to cross-walk over to Suboxone. Someone I am working with did this successfully. For him the dose of methadone had to come down to 30 mg. At that point, he could get on Suboxone. This was not easy though. Suboxone demands that the person be in withdrawals from opioids and this includes legally prescribed methadone. He was quite uncomfortable with methadone withdrawals but he succeeded.
I wouldn’t suggest your son consider this until he is much more stable, on the correct methadone dose, managing his alcohol use. We may be talking a year or more.
Yes, recovery coach, sober house … Boston Medical Center has good programs. You can call and talk to someone. As far as I know, it is all outpatient but they must know of recovery coaches. They should also refer to sober/transitional housing in the Boston area.
Your son is accepting treatment: methadone, detox. This is such a good sign. If he has burned out on AA, perhaps a different kind of peer support group like SMART recovery. Recovery centers are opening around the state. They offer many different kinds of groups and other supports. They can also link your son up with a recovery coach. Here is one to start.
So, you have some work to do: Call BMC, call this recovery center or others nearer to your son to see what is offered.
Your son has transitioned from alcohol to opioids. He still drinks. Perhaps you start with supporting him on Methadone, and providing him with BMC and recovery centered programs. He does need to address the alcohol. As a first step though, let’s make sure he is protected from opioid use.
Thank you for being there for your son, after all of this time. What a long road it has been for everyone. It’s positive that there are lines of communication between you, and that you are in conversation with him about his treatment. The more you show up as an ally for him, with an emphasis on working in partnership with him, the better. On your end, anything you can do to improve your listening and communication skills, as taught in Learning Module 4, will also help a great deal.
Your goal of getting sound evaluations for depression, and anxiety management sounds right on target. For the immediate future, though, let’s focus on the methadone dosage and finding new recovery supports for him. There will be room for the rest once he’s more stabilized. Thanks for your questions. We are here for you – keep letting us know how we can help.
Dear Lucy:
Over the last 15 years working in the Substance Use Disorder field, I have fielded numerous statements/questions like this from Parents, wondering how they may be able to effect change in their children. The telling comment in your note begins with – “I think he needs a good evaluation for….” That’s where the real issues rests – until your son believes he needs an evaluation for anything, not much will happen. All forms of Medication Assisted Treatment should incorporate psycho-therapeutic involvement. Note – you have already determined that depression and anxiety are being treated by substances prescribed by the user – your son, and not a physician. Before you get anywhere near the myriad issues surrounding why your son is enmired in self-medication, I would really suggest reaching out to a therapist/counselor for your own needs at the moment, which are really of paramount importance. Anyone who has worked in the Treatment field will most likely urge you to get some assistance for your own anxiety that no doubt is fueled by the realization that your son’s actions are beyond your control. If he is in detox, and IF he expressed a desire to remain in treatment, he will probably leave the facility with a preliminary plan of action. Before he leaves, get ready for how YOU are going to handle what happens in your own home, and in your own life, when he returns, most likely asking for financial and residential support. Very difficult material to handle on your own… try and get some support before you move forward.