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How Long Until the Methadone Really Starts to Work?

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PThasnohead is treading a very fine with his partner. She has agreed to a certain level of treatment, but it seems like such a long time before she will be off the drugs altogether. As he holds a CRAFT stance, she often grows angry, and tensions are high. How much time should we wait before trying something new?

Have seen mixed results and not sure the best way to proceed but frustration and exhaustion are really high on both ends.

On Tuesday she went to the ER for an abscess on her leg. She talked about how disappointed she was in herself and how it felt like a setback and how she wanted to make sure this didn’t happen again. I took this as a dip and saw an opportunity to bring up additional treatment. I thought I’d wait till the next day to talk about it.

Treatment itself has been mixed, she has missed about half the days getting methadone and had her dosage stopped because she wasn’t doing what they require new patients to the program to do. What was happening was she was spending 8+ hours a day at her dealers, coming home late and continuing to use meth until 5am and unable to wake up to get things done. Methadone did give her back her mornings and make it so she wasn’t so desperate to secure her next fix. She did too after having the dosage be stopped get determined to do everything she needs (blood tests, group orientations)

Meanwhile her use of both heroin and meth have stayed pretty much the same, combined with her spending more and more time at her dealers, not coming home at night and the formication problem is the same. She has also been taking my car (no drivers license). In general her life is still 100% revolving around her use. Read this member’s full comment here.

Your girlfriend has started methadone yet she was not going everyday. A doctor will start dosing with methadone and will continue to raise the dose until the person stops craving. The spottiness of her attendance at the methadone clinic probably made it difficult to follow their usual guidelines. Once the methadone dose is right, she should stop using the heroin. This can take weeks. Since they are working with her again, and she has redoubled her efforts since the leg abscess, the heroin use should drop. Things should start to level out very soon.

The methadone clinic should be seeing the methamphetamine in her urine toxicology tests and addressing this as well, to the degree they can. They can talk to her about it, they can refer her to additional treatment, they can leverage her using the methadone.

Your instinct to back off, be loving, and let this move at its own pace for another couple weeks are all good strategies. Removing the use of your phone and computer is also sound. Providing her with ideas of additional things she can do is absolutely CRAFTY – great job with all of this.

This must be extremely hard on you. You are doing what you can, so yes, back away for a couple more weeks. Avoid the hard talk and the arguments. Let the methadone provider do what they can to get her stable on the methadone. Give them a chance to also address the methamphetamine.

If things don’t start to calm down in a couple more weeks, then a more intensive level of care is needed. (Though it may be needed now, we should let her try with methadone first). Have you looked into additional treatment in your area? Methadone + residential + psychiatry? The study of methamphetamine treatments is thin. It’s a very tough drug. Here is what we do know about treatments.

Thank you for being willing to stay in her life and to help her get to what is needed. Many people would just walk. You want to give her a chance to see this treatment through, and you are doing your part, creating an environment that is most supportive of her getting the treatment she needs. Your efforts here have been heroic. It is probably impossible to express how hard you have been working behind the scenes, even just in the past few months, to create an opening for new and healing patterns in your lives. We applaud this work, and know how thankless it can feel.

She seems to be perceiving your current efforts as controlling. That must be enormously frustrating. You are continuing to try to stay open-minded, loving and compassionate with her, while also drawing important lines that show what you are and aren’t willing to do. These lines, and the way you are communicating and engaging with her, are sending an important message. Whether she likes the message or not – or even fully understands it – is a different story. As her partner, you are treading a very challenging line indeed.

Even if she reacts against the stance you are taking, there are moments when she does open up to you. Somewhere in her, she knows that at the end of the day, you are there for her to encourage and support the best path for her. Clearly, there is a part of her that isn’t fully ready for that yet. And there is so much that is still problematic with her behavior and use. But there remains some part of her that knows that the better path that you are holding for her, and that you see, is possible.

At some point, with this level of use, the toll on a family member or partner’s mental and emotional health becomes significant enough that it simply can't stay on the back burner any more. If you think of these next few weeks as a time to step back and see what progress she can make with the support of the clinic, perhaps now is an opportune time to focus on the positive impact you can bring about – in your own life.

It must be so hard to grapple with the frustrations of her being gone for so many hours on end and having her daily activities so fully revolving around the drug use. Try making a pact with yourself about how much time you will allow yourself to entertain the thought patterns you inevitably have about this – and then close the door on them. Make a commitment to go out of your way to treat yourself as you know you deserve to be treated. Reach out to someone who is a compassionate listener, who reminds you about showing love and appreciation to yourself. Without any strings attached to your other responsibilities – which are clearly many – find a way to explore something new and inspiring in your area. Even just for a few hours, if you can spare them, do something you would never normally do for yourself. These gestures are substantial for our health and well-being.

Now is a great time for this kind of shift. Do anything you can to tend to your own needs. Your partner’s needs are very different from yours right now, and you have been so attuned to her situation. This takes so much time and energy. Especially considering how much you are shouldering, your needs are just as vital.

Seeing what progress is possible in the next few weeks while you step back is also a way of distancing yourself from patterns of the past. In any relationship, a little distance can help bring things into better focus. From a different vantage point, perhaps you can see new ways that you might be able to step in next time you do sit down with her to talk about the hard things. But in the meantime, give yourself some credit, and let things fall where they will for a while. You need a break.



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. I think I’m at the end of my rope and out of patience to properly communicate. I feel like it’s time to kick her out and cut her off. I just want to do it in a way and communicate it in a way that still shows her love and with a path where if she was truly dedicated to her recovery, I could reengage and help.

    In the past 8 months or so she has been going to treatment sporadically. She has been taking methadone but stuck at a lower dosage because she isn’t showing up consistently enough or doing the other things needed.

    She has continued using basically the same amount of heroin and meth while in the program but is claiming she is doing better because she says she is using less. At no point has she gone without using at all.

    Her pattern of behavior has generally only worsened. She stays up till 5am using, then is unable to wake up to walk the 5 blocks to the treatment facility. She continues to spend all of her time at her drug dealers to do what she needs to get her fix for the day. Which I am pretty confident one of them is now prostituting her out. She continues disappearing for days on end with no text or phone calls. She will steal my car while I’m sleeping and drive her drug dealers around in it to earn her fix. And she has gotten thousands of dollars in parking tickets from this, I had no idea about until my paychecks started getting garnished.

    She has trashed my apartment and financially put so much strain on me I’m on the verge of being evicted. I’m not doing well at work. No matter how I try to guard myself from this affecting me from my own doctors, addiction counselor, groups, reading, relying on friends and family, I feel like I’m at a breaking point emotionally/physically and financially.

    I am unable to talk to her about any of her behaviors, no matter how I try to discuss it using tools I’ve learned from here and SMART recovery for friends and family. She just wants praise because she sometimes gets methadone, without seeing a doctor, going to groups, refusing trying DBT, basically doing any of the mental work. I explain to her it’s like if her recovery was a marathon she stopped a mile in to say “look how good I’m doing, I’m running a marathon” and just stopped.

    The hard part too is she has these dealers who will help her out, so she has no urgency to get methadone, if she sleeps in and misses it, it’s okay because she can just get more heroin.

    I think the clinic is so overwhelmed with patients and them not wanting to kick people off of treatment that they let her skate by without doing anything else or having clean tests. I have tried during dips to communicate there is other stuff to help, had the phone numbers ready, for inpatient, dbt, her own psychiatrist, other M.A.T. Options and she gets upset that I am not positive about the progress she has made and being negative about the parts she is doing better at. This to me feels like a tactic she is employing to try to get me to be ok with what she’s doing.

    My sister in law is in charge of addiction medicine programs for our state and been a good resource.

    I feel like kicking her out is like giving up on her and letting her live in the streets but I also know at this point I am just helping her maintain her current lifestyle and not letting the reality of her choices set in. She recently had the flu for a month that had 3 ER visits and she still didn’t see that was her body telling her it can’t do it anymore.

    Any kind of attempt to talk to her gets her to blow up and leave, so any attempt to say enough is enough won’t go well.
    I just feel like there is nothing that can be done if she is unwilling to fully commit to recovery and continues down her current path.

    I want to give her a note that says I love her, believe in her and am not giving up on her. With some other things along those lines but letting her know her current path isn’t going to work, if she stops using entirely and proves she is working on it she can come back, then give her the phone numbers and places of different things she can look at.

    It’s just crushing though, even though I don’t have control over her decisions, I feel like I utterly failed her In what was such an important thing.

    I so badly want to help and at this point I don’t think I am.

    1. My goodness, so much love comes through in your retelling of the situation. You have been on the site for months and have tried hard to communicate better and to generally maintain your boundaries with your partner. You have not failed your partner. You have given her the most solid direction and support that you could.

      Your partner is doing a few things to address her drug use but it is not enough for either of you. At some point you have to decide you tried your best, using the best strategies that science and psychology have to offer. The rest is up to her.

      I hope you realize you are a rare bird. Many people would have walked a long time ago.

      Read Dominique Simon-Levine’s full response to PThasnohead here:

  2. I’m exhausted, she’s exhausted. I feel like my boundaries I set to keep my sanity keep getting run over. Her recovery is moving forward slowly but everything else is boiling over.

    I think I may have reached the end of my rope, and my lack of patience for her behavior has made her reach her end of the rope for wanting to be home.

    There have been a lot of good developments in the past 3 months. but still using and selfish behaviors that come with that.

    When she first started Methadone she had a hard time going regularly. She then made a big step in her recovery by cutting her dealer out of her life, who required her to be at his apartment 8 hours a day for her to get her free dose.

    Her dosage still wasn’t high enough for her to not need to use (so she said) so things were a bit chaotic for her.

    For a month she told me she was going when she wasn’t at all. With lots of the tools I learned here and with SMART Recovery, I was able to communicate with her to get back at it.

    This time around they were more aggressive with starting her out with a higher dose, which was very helpful, she has been consistently going for 2 months, but she says she still isnt getting her full dose so she needs to still continue to use.

    During this time though she got her drivers license, license to work again, been home more and communicated better.

    However, with that she also borrowed my car, would be very late picking me up from work because she was running errands (non-drug related I hope) for her dealer, started stealing money since she cut off her dealer that would give her free drugs. Also, leaving her dog that can’t be left alone because her dealer didn’t want him around.

    These were my boundaries she can’t stick to.

    I have been trying to get her to sign a release so I can talk to her clinic and her doctor about her treatment. Also so they can tell me if she is going since she lied to me about it for a month. but she refuses to do that no matter what.

    She also is not doing anything to work on her behaviors or treatment, outside methadone. The clinic is so understaffed I don’t think she even has been assigned a doctor there yet.

    She has mentioned wanting to do DBT therapy and find a group as she goes a long but so far none of that has happened.

    I have been asking and pressuring her to do all of that a lot. I’ve tried in a lot of different ways to encourage it but she doesn’t. A long with her not willing to sign a release where I can know if she is still expected to be using being on methadone for 2 months.

    Her reconnecting with her old dealer to is such a monumental setback for her recovery.

    A couple clear boundaries I have set is to not take my car and strand me with her dog, that keeps happening over and over again.

    I am trying to take a step back and look at the positive steps she has made and be understanding that her dosage may not be high enough for her to quit using. But since she won’t sign a release, I have no way of knowing if it’s true.

    I wan’t to be able to sit back and let her work her treatment with the help of the clinic but nothing other than dosing is occurring and I’m completely in the dark.I don’t know what to do, let a lone even how to communicate.

    I had told her she can’t come home until she signs the release, finds a group, finds a doctor, starts DBT and cuts off her dealer that gives her free drugs.

    But my gut is telling me to just step back, celebrate what she is doing. To keep my sanity with my boundaries by just not allowing her to drive my car would solve a lot of it. Then slowly try communicating and using different ways to encourage her adding the other things to her recovery.

    There is also a line drawn in the sand, over her signing a release of information, not sure if I should back off there.

    1. I sense progress with your partner. She is taking Methadone. The clinic knows that she is still using illicit drugs through urine tests. They are increasing the dose and will likely continue until the cravings and the illicit drugs stop. It takes a while to get the dose right. Hang in there. Yes, the system for medication is swamped. It is best not to depend on their ability to refer and insist on other treatments.

      DBT is a very good next step. (see our description in the supplement) You can’t expect your Loved One to find this however. It is going to be up to you. Can you find a group that has openings? You are going to have to help figure out transport, payment, dog care (sorry).

      You are both on the right course. Please hang on! Take care of yourself, forget the release of information for now.