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I Can’t Tell When He’s High on Suboxone

hand extended

danareilly is unsure of whether or not (and when) her son is using suboxone (not doctor-prescribed). She seems him infrequently, but their exchanges are positive overall. She's unclear on whether to reward or not…

"Dear Allies: I am the mother of a 35 year old man who has struggled with heroin addiction for over 10 years. He doesn't live at my home, works a restaurant job, and mostly pays his own way, although in the past, periodically I have given him money. Now, I only give him checks on his birthday and Christmas. He says he is taking Suboxone, but he says he gets this from a friend and isn't going through medical channels, Medicaid, etc. He has been in a state-run detox and 21 day program about 4 years ago.

 He is saying he wants to put a plan into place to change his life and get off drugs, but when I talk to him, he doesn't get too specific. He says the program he was in in the past didn't fail, that he failed. I have attended Al-Anon for the past 4 years, but now am beginning therapy due to fear and anxiety and wanting to help, but wanting to help the right way. So, I am thankful for Allies!!

My questions are around the fact that I don't know whether he is using or not using (he probably is using Suboxone), so the idea of rewarding non-use and withdrawing rewards for use is hard to apply. I know the importance of timing (it has to be his timing) and his motivation, but the longer he waits, the more fearful I become. How can I apply the principles of Allies when I don't know clearly about use and non-use? I now know some of the symptoms of heroin use, but I only see him 1 or 2 times a month at the most. We go out to lunch and then he loves to go to a bookstore, where I buy him books. He is a voracious reader and I spend some money doing this. I could stop buying books, but that could be seen as punishment, and I've tried to just keep a connection and a channel for communication that is positive and rewarding (e.g., lunch and books). What can I do? I guess it's always possible that I just have to keep waiting. Should I stop seeing him until he makes a decision to go into treatment? (That doesn't seem quite right.) Should I offer to help him with a game plan that has rewards after certain steps are completed – like a flow chart or something? Thanks for your support!"

Your instincts vis a vis your son who is a long-time user of opiates are good. You have kept up your connection with him. He is sharing his fears, and his hope to make a plan and get off the drugs. When you see him, you keep it light and do things he likes.

The worry of rewarding use is real, and you are just not sure whether he is high or not when you see him. We wrote a piece about rewarding someone when street-bought suboxone is on board. It is hard to tell the difference when someone is high from opiates, if they are long-time users and are just maintaining—they just appear normal. Suboxone can look the same: they just appear normal. Because you see your son so rarely you won’t know the patterns that would help inform your guess as to whether he is high or not.

So err on the positive and reward him. It is a small but important thing you do for each other.

CRAFT, in Learning Module 8, describes the help a family can give with formulating a treatment plan. You are a key resource. You are in much better shape to research what is available than is you son. The treatment system is complicated. Access to treatment is fraught with barriers.

I once worked with a wife who found her husband, yet again, passed out on the kitchen floor, having drunk himself into a stupor the night before. She grabbed the kids, put the HMO card by his head, and went to her mother’s. I suggested that next time this happened, perhaps she could put a list of HMO reimbursable treatments by his head. That list should include every detail needed so that the Loved One has only to pick up the phone or show up at the door of treatment.

We just can’t expect our Loved Ones to figure this stuff out. Not with the state of substance abuse treatment in this country. Your son is lucky to have you. Reach your hand down the hole in which he finds himself and give him a hand out.

Helping unblock treatment is a key action a family can take. Thank you for your question.



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 find it very difficult to detect opiate use. My mechanic told me he was on opiates for his back and he let me study his pupils. So, yes, they were very small. I looked at the other guys working there and the other two were on opiates too. It freaked me out. All three of the guys at the front desk were on prescriptions opiates for back problems. Of course, I am looking for the difference between 2mm pupils and “pinpoints”. On top of that opiates are clearly being prescribed at a record pace still. I have had back pain before and was glad to have Vicodin so I’m not judging.

    This episode has taught me a couple of things: before I can reward non-use I need to know what it looks like and I’m not confident yet, and number two if my son goes to a doctor with any type of pain these doctors are pushing opiates on everyone. I want to prepare him for that day at some point yet first things first.

    Thank God my son chose to go to recovery in May and now has a job and likes living in the sober living house with others recovering. I am glad you’ve written this article and your recommendation is to err on the side of rewards yet still I am hoping there could be some “tell” in order to “know” with some degree of certainty.

    I am certain that CRAFT in addition and correction at times to Al Anon is the answer. I wish I could get my entire family to listen to all the Coming Up for Air podcasts yet I am waiting for their Al Anon “wishes and dips” in order to suggest AIR for them. They still think almost any contact at all with our LO is enabling that they learned from well meaning scared people in Al Anon. Honestly, since they clearly don’t have the CRAFT tools they are indeed better off staying away from the LO until they learn the tools to keep a healthy relationship like reflective listening and rewarding non-use. Again, if I can’t tell non-use then the rest of my family will be having as much or more trouble with this. So when it comes to hard to read opiate addicts its almost better possibly that the LO only trusts me mainly and that the others are strictly scared off and adhering to their version of “detach with love”.

    Keep up the efforts on these difficult subjects and encouraging and understanding LO’s w/SUD.

    Thank you.

  2. Thank you for sharing this. It was an important read for me today. I also feel afraid that I am misreading things but then my daughter is still using alcohol. I am fortunate that it doesn’t take much to bump up my spirits but time and again the hopes are dashed. My daughter says she is starting a program and it’s one that I recommended. Being in the position of support person as well as provider of simple rewards works for me but I don’t want to be taken for a fool so I constantly ask myself if she’s lying.
    danareilly hang in there. The book rewards sound like an excellent idea.