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How Will He Ever Get Treatment with Addiction, Medical & Mental Issues?


Gardenmom1 wonders about the numerous roadblocks in the system when it comes to getting treatment for her son who suffers not only from addiction, but also PTSD, depression and cardiac issues.

"I am just letting out steam really. I find it quite difficult to find an opiod treatment program for anyone who also has medical issues. The resources listed in the community seem to look good on paper…but then the reality sets in when the time comes for action.

A family member is male, age 30 but also has a pacemaker implanted for his heart condition. He is taking suboxone and does not like the way it makes him feel, but he has followed the doctors direction. He seems to have difficulty getting off the suboxone without causing cardiac issues when he gets to the smallest dose. He also has severe PTSD and major depression and is followed by a psychiatrist and therapist.

When he has lost sobriety and needed detox or a longer term placement the big "NO" sign comes up because of cardiac and mental health issues. He has gone into a detox and was not given his cardiac medication because "they don't do that", which was dangerous or he was accepted for a few days and sent home on suboxone. His insurance refuses to cover any treatment for more than a few days. He has no financial resources to live at a program short term to really get the support he needs.

My frustration is there seems to be a lack of residential treatment for anyone who suffers from addiction who does not have the financial means to pay privately. When you add in a mental health diagnosis or serious medical condition an even bigger wall goes up. He is thankful for the day or two he gets in detox, follows up with outpatient treatment but eventually transportation from friends dries up. There is no public transportation where he lives. It is easier to find opiods in an isolated community than it is to find treatment options. Very sad to say."

Dear Gardenmom1:

It can be difficult to find treatment under the best of conditions. The public system is often overwhelmed, especially in the winter. Insurance is still limited when it comes to paying for addiction treatment, as you have found out with medical detoxification.

Medical detoxification treats the physical withdrawals only, so out you go after a couple days. Detoxification units are not set up to treat people with serious medical conditions. There are sober houses that are reasonable in price but they can be uneven in quality and may not want to take the chance on someone who has major medical and mental health issues. And yes, transportation—and child care—continue to be major barriers for people getting to treatment.

We have people on this site who work in the treatment system or for the state. I wonder if they have any ideas that could be helpful. Which Clinical Stabilization Services (CSS) and Transitional Support Services (TSS) can take someone with a cardiac issue? Insurance could maybe be pushed to pay for two weeks in residential care, but where can this individual go privately given his health issue?

When Allies in Recovery worked as a community service we employed a wonderful person whose job it was in part to hunt down treatment. She would spend hours, over days, on the phone looking for appropriate care for the families’ Loved Ones we were seeing. The hours on the phone often translated to just a couple entries on an otherwise blank sheet of paper. We inevitably felt the need to justify the work that had gone into these skimpy little lists. The job was pretty thankless and frustrating for everyone.

States like Massachusetts are opening new beds and understand the need for treatment on demand. As the head of a detox unit once said to me: the system thinks in terms of beds while people with addiction think in terms of hours. Treatment on demand, including treatment for special needs like serious mental illness and co-morbid medical conditions, is the answer to the addiction epidemic.

It can take several treatment episodes to get any traction into recovery. Being able to walk in when that small window of willingness is open is key to our efforts at resolving the epidemic. 



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. My 26 year old son is a heroin and meth user, though he prefers heroin. He lives with us and we don’t allow him to have drugs in our house, which he seldom obeys that request. If I happen to catch him passed out and find his heroin, etc., I will confiscate and not return. He now is trying to convince me that he would be better off just getting a little bit of heroin from me rather than going out and getting more, or using something else. I don’t relent, he takes meth, and then stays up all night ransacking our home searching for his heroin. I go to bed worried that he will leave and OD somewhere else, or get in a car crash, but then I wake up to a total mess of a house. He says that he wants to go back into rehab. but wait until the end of the month because of the quarantine and the minimal service that they are receiving. Plus, he has a court case he wants to look good for in July! I guess my question is, should I have provided a little bit of heroin to get him through until he goes back into detox/rehab or let him go out and just get more with all the implied risks?

    1. Your son is using methamphetamine and heroin. He has a court case coming up and knows that getting treated for his addiction will look good to the judge. You have a motivated Loved One.

      The question is whether to give your son a little heroin each day so he would not re-offend, and so that he would otherwise calm down a bit in your house. He is really running rough-shod through your house and this all must be extremely trying to your patience. It’s good that you wrote in to share your situation and seek some guidance. What a huge decision to be faced with.

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

  2. Hello, I have tried my best to follow the Craft method but I lost my ability to control how upset I was. I’ll briefly try to explain what has happened over the past year and what lead to my verbally lashing out.
    My husband went from abusing pills orally to IV heroin//fentanyl mixed with some other chemicals mixed in. He spent all his retirement money, I emphasize “his” because as he said, he earned it, it was about $120,000.00! after taxes. I got stuck paying the taxes by the way. The IRS said I am responsible and should know what my husband is doing! I had to take the little IRA I had to pay the IRS and bills. He has taken out loans in his name only and spent his monthly pension check too. I’m out of work with a fractured neck, so I barely get $500.00 a month. I have no rights to have a representative payer applied to his retirement account, even under these circumstances. I made a separate checking account when my husband lost his sobriety because he took that money too.

    I went to court and had him placed with a Section 35. That did no good because he met some new dealers and friends with the staff! I tried to complain and it did no good because I can’t prove it even though I presented their names and phone numbers I found. If he received or accepted any treatment while locked up, I have no idea because nothing changed. He was put in a van and sent home with no discussion with me. I called the police once to try and intervene with getting him help because he was intoxicated on IV drugs, and got in the car and left, but he got arrested, they took him to the ATM to bail himself out. He got himself a lawyer and that was that.

    I have been advised to get a divorce, but how does someone do that with little money? I tried pro bono lawyers but that isn’t working. The courts are closed but I did fill out a separate support form hoping the court can do something to protect myself and our son from losing everything. I tried legal aide, you name it and can’t get any financial assistance. The fact that I had worked also impedes me because the agencies look back on income. They don’t take into account that my husband took all of our savings too. We both had credit scores near 800 when this horror show started. We will lose our house because I can’t pay the mortgage, he refuses to pay that. I lost control of my emotions when he said “tough sh..! I have the money to find a place, have a nice day!” I have been married over 30 years, worked hard my whole life and this is what I get. My husband was over 20 years sober from alcohol and he said he had never done drugs. I don’t know this man at all. I could write 10 more pages of what he has put us through along with all the other family stress and losses that caused me to lose it.

    Sometimes it seems, even with all the wonderful agencies out there to provide support, if a person doesn’t fit in a certain little block, you are not eligible. All the phone number and referrals they give you end up being more of the same. This is very difficult to even write about because I am a private person and don’t intend on sounding like poor me. A part of me wishes I didn’t even try to save our marriage 2 years ago, because none of it worked. It gave him time in his deceitful way, to protect himself while pretending to work on our marriage and his sobriety. I don’t have a devious mind and sincerely did everything in my power to honor my vows and commitment to our relationship. I have never been so depressed in my life. I have support systems in place, but honestly I am shattered. I won’t hurt myself because of my son. I did change my proxy away from my husband but if I get really sick I don’t want to be saved, it’s in writing. At least when I am gone, my son would be able to cover expenses I have and hopefully finish school and move away from this nightmare. Thank you for all you do for those trying to cope with substance abuse. Bless you.

    1. Your story is heartbreaking. Your husband relapsed after 20 years of sobriety and is now using opioids. You describe him as someone you just don’t know now. He has wiped out your finances and left you in danger of losing your house. Your many efforts to protect yourself have largely failed. You sound very very low. How utterly exhausted you must be. These feelings you describe are all valid. Having endured all that you describe, it seems inevitable that you’re experiencing a wide and complex range of emotions.

      After 30 years of marriage, you want out. Your question for us is how to get out. You feel like you have nothing left to give your husband in terms of support or CRAFT or anything. This makes sense.

      Read Dominique Simon-Levine’s full response to Gardenmom1 here:

  3. This post was very interesting for me to read as a Director of a DPH contracted residential treatment facility. It strikes me that family members are often frustrated by what they perceive to be recalcitrance on the part of treatment providers, and often this perception is gained from feedback they receive from their family member who is either in treatment, or from a lack of complete information regarding the complexities of insurance coverage, particularly with regard to substance use disorder treatment.
    First, individuals need to recognize that “Detox” units are operating under the guideline that they provide services to individuals who are experiencing “medical necessity” – this means that they may be in imminent danger of severe physical consequences from withdrawal if their medical issues are not addressed. In the case of alcohol withdrawal, there is significant danger of stroke, cardiac arrest, and potential lethal consequences if withdrawal symptoms are not managed correctly. When it comes to administration of appropriate medication, medical directors at Detox units must make that determination, and when clients arrive without their medication, problems arise. It has been my experience over the years that people arriving at a Detox unit, as opposed to the Emergency room, with significant cardiac issues, may have gone to the wrong level of care. Detox units are equipped to handle withdrawal symptoms, but when they are heightened by pre-existing cardiac issues, it often taxes their capacity to provide appropriate services. It’s not that “they don’t do that here”, but rather they recognize the imminent danger the client is in, and often seek to get them into an ICU, or some other more appropriate level of care.
    Second, the use of MAT (Medication Assisted Treatment) protocols does create issues when it comes to synergistic reactions with other medications. People entering detox units rarely bring their medication with them, and most cardiac medications are managed carefully and deliberately by Primary Care Providers. If the PCP is not notified that the client is now in detox, and communications not established with he/she and the unit, then difficulties will arise with regard to medication. It is not that treatment facilities do not treat people with heart issues. My house routinely admits men on cardiac management medications. The real issue is whether the primary care physician is involved early on, communicating with the various levels of care that the client is moving through.
    Finally, we need to understand that complex medical issues require diligence and commitment, and when individuals are not compliant with their medications, and suffer with SUD on top of that, they are creating harmful situations for themselves. State funded facilities do the best they can to deal with the complex conditions clients present with… mental health issues, physical health conditions, and financial difficulties. Treatment is designed for SUD as a priority… when someone has a primary health condition that is beyond the scope of substance use disorder facilities, they need to be in a hospital. At my house, we help men attach to services, help them look for gainful employment, and help them learn how to take responsibility for their health while they stay with us. The only barrier to admission is their willingness to take responsibility for conditions they have, and their willingness to commit to staying with us long enough for things to settle down and achieve stability. DPH funds their stay, with assistance from MA Health, so to a certain extent, finances are not an issue initially. They do, however, have to work eventually, and start taking responsibility for managing their lives so they can stay out of the complex and confusing system that this post was describing in the beginning. I know this was lengthy, but I often feel that people are seeking quick simple fixes for conditions that have often grown terribly complex over years of personal mismanagement.