I Don’t Know What’s Right Anymore

iagirlsmom has reached the end of her rope. It seems impossible to make the right decision anymore. Her Loved One has been in a state of extreme chaos for years, and cycles through a whirlwind of violence and use. She is calling for help, the consequences of her use spiraling out of control. But can the family bear to be there for her and try to rescue her once again? 

We don't know what's right anymore. We don't know what to do. Our daughter will be 24 Sunday. She went from college student to totally non-functioning addict. She has been been in 8 inpatient facilities, multiple outpatient programs, approx. 25 hospitalizations in 2 1/2 years (9 in the last 4 months), 3 or 4 psych holds/stays, and 1 involuntary committal we got through the county. She relapses immediately, kicked out of multiple sober houses. Hasn't kept a job in all this time. We had been paying for all her housing/rent, sober living, medical insurance/deductibles/copays/max out of pocket/medications, breathylzer in her car, etc…We are financially at the end of our rope with no end in sight. (We haven't come up with the money to pay the residuals of all the recent hospitalizations – about $9,000) She is unbelievably promiscuous. desperate for a man but then steps on whoever that happens to be. She's recently been with a 31 yr old male she met in one of the latest rehabs. She reports that he hits her and that appears as a result of her cheating on him. She is now saying she is being raped. She says she went with a stranger to get meth. She reports various physical altercations and also of assaulting others. She is total chaos and just continues to drink or use or whatever and up the ante of all this bad stuff over and over and over. Now the man has left her again apparently and she is calling us constantly drunk/high or whatever crying and begging about us not coming to help her after being raped and being all alone and wanting someone to come take care of her. I can't possibly list all the things we have gone through and done for her over this period. We don't know what to believe and don't know where to go from here. We are out of financial resources and don't know what else we can give or do for her. I know it's horrible to not go to your daughter who says she was raped. I can't imagine what the hospital thinks. I can't believe this is her life. I can't believe this is ours. I don't know what to do anymore.
 

You poor dears. We have been following your story since last August. Your daughter is still using drugs (now methamphetamine) and drinking every chance she can, whenever she isn’t in treatment. You have provided all the help you can to get her into many different treatments. You are burned out and sound hopeless. It is completely understandable.

We have talked before about civil commitments. You have tried it once. Can you try it again, and even potentially again after that if needed? Your daughter could probably write the curriculum for a treatment center. She has certainly received lots of education on addiction at these centers. At this point, she is in serious danger, running with men who mistreat her, getting raped, and living in the streets when not at your house.
 

You are not equipped to handle this level of crisis and danger. The drugs your daughter is taking are even more serious than before. She can’t be home.
 

I went through the Substance Abuse and Mental Health Services Administration grant recipients for Iowa for 2019.

Below are three grants that might be worth contacting. Grant funded programs are typically free to the recipient. I don’t know where you are in Iowa or how close you might be to neighboring states with additional grants. Go to the SAMHSA.gov site to look at who is being funded in your area – this is one way to find free quality treatment and case management services (click here for our page on Treatment Finding Resources, in our Resource Supplement). There are also other grant funded years to look through.

*see the end of this post for a detailed description of each of the following grants:

Grantee: IOWA STATE DEPT OF PUBLIC HEALTH
Program: PIPBHC
City: DES MOINES
State: IA
Grant Award Number: 5 H79 SM080241-02
Congressional District: 3
FY 2019 Funding: $1,785,075
Project Period: 2018/09/30 – 2023/09/29
 

Grantee: AREA SUBSTANCE ABUSE COUNCIL, INC.
Program: GBHI
City: CEDAR RAPIDS
State: IA
Grant Award Number: 5 H79 TI080490-02
Congressional District: 1
FY 2019 Funding: $400,000
Project Period: 2018/09/30 – 2023/09/29
 

Grantee: PRIMARY HEALTH CARE, INC.
Program: GBHI
City: Des Moines
State: IA
Grant Award Number: 5 H79 TI080466-02
Congressional District: 3
FY 2019 Funding: $400,000
Project Period: 2018/09/30 – 2023/09/29

For each of these, see if you can get to someone senior in the project to see if your daughter could be a fit.

Families, if at all possible, should continue to encourage treatment. Because it didn’t work before is not a predictor of whether or not it will work the next time. Your daughter is indeed an example of the multiple treatment episodes that may be needed. You are caught in the middle of this, and it is draining you of all your resources, patience and peace of mind. Don’t give up on her BUT don’t give up either on the need to protect yourselves emotionally and otherwise from her troubles.

As she is begging you to come get her, for someone to take care of her, try to reach deep within and find the stamina you need to sit with her neutrally, compassionately, and lovingly, and say something like this: 

I love you. I’m beside myself thinking about the state you’re constantly in. I don’t know what to do. I want you to be safe. I know you are suffering, and you are dealing with some very serious and scary situations. I want to be here for you. I’m weary and drained though. I can’t take care of your problems, or solve them for you, but I am here for you, and ready to help you get to safety. Here is a list of places with openings right now and what you need to get in. It includes the phone number and person to ask for when I could get it. Let me know. I love you, always.

The sentiments you express about not knowing what’s right anymore are a clear indicator that your energies are completely sapped. Such a state of despair is to be expected considering everything you’ve gone through. You are exhausted, drained and suffering because of all of this. How can you see clearly in such a state? It’s impossible.

In a post a while back, a parent wrote in feeling as if they were simply too exhausted to practice CRAFT. This is legitimate. Here is an excerpt from our response:  "If you’ve hit a wall and your receptivity to the modules, etc is at a low, you can’t force your way through. Rest, digest your feelings, find a way to make peace with them and let them go. Then come back to things fresh and know that you are doing a great job. Know that you can find your way back in with compassion for yourself and an open heart. Let the pressure off yourself. You are doing a great job."

If you truly cannot see your way through, it’s high time to make caring for yourself a serious priority. Your daughter’s lifestyle has taken a toll on her, on those around her, and on you. You can’t change that. But you can begin to work on your own well-being regardless of the external circumstances. Only when you have devoted that time to yourself will you be able to see things anew and have enough energy to set it up again. 

That said, we do maintain that the family member should lead their Loved One toward treatment, again and again, by using CRAFT. Right now she is vulnerable and reaching out. Treatment is what she needs. Her progress appears to evaporate as soon as she leaves treatment, but treatment remains the goal. She does better in treatment than out of it, that’s for sure.

Continuity of care would be so beneficial in her situation. Not having to start from scratch with a new counselor, caseworker, etc. with each and every stint. She has been flailing for some time now. She is also finding herself in increasingly dangerous situations. It seems impossible to fathom as a parent how things can come to this.

It is fair to say that she is undoubtedly grappling with crippling trauma on multiple levels. It’s not your job to determine whether or not she is telling the truth about the recent trauma she claims to have been through. Your job is to be there when she reaches out, and usher her towards treatment whenever possible. A trauma-informed approach does seems to be called for, regardless of the details of her current situation. Here are some resources on our site that may be helpful.

Resident expert, Dr. John Fitzgerald, has written about this topic before on our site. Here is his website, and here is a new resource he has created: 5-actions.com. He just rolled out this site, which serves as online support for the person with addiction. We are excited about this new resource that puts valuable tools in the hands of our Loved Ones, crafted by an esteemed and seasoned professional. We strongly encourage you to include this resource, along with anything else that jumps out at you from our online support resource, to give to your daughter along with other treatment options the next time you have the opportunity.

You have a tremendous amount on your plate right now. A civil commitment is definitely an option to consider, along with a number of other possibilities that we have suggested above. We implore you to heed the call to invest in self-care right now as well. It breaks our hearts to hear of this level of stress and chaos you've all been enduring. We wish we could envelop you – and everyone in your family – with the love and support you need right now. There is too much to process and navigate without having some semblance of well-being to pull from.  We offer you our heartfelt prayers for you to be able to face this with compassion, strength and clarity.

*See below for detailed info on the grants described earlier in this post:
 

Grantee: IOWA STATE DEPT OF PUBLIC HEALTH
Program: PIPBHC
City: DES MOINES
State: IA
Grant Award Number: 5 H79 SM080241-02
Congressional District: 3
FY 2019 Funding: $1,785,075
Project Period: 2018/09/30 – 2023/09/29

Iowa proposes to provide integrated mental health care, primary health care and substance use services for adults with substance use disorders as the special population of focus. Sub-populations of focus will include individuals with SUD and chronic physical health conditions and individuals with SUD with SMI (Serious Mental Illness). Iowa's Integration Project model will utilize an Integrated Care Team (ICT) that will provide bidirectional care through screening for behavioral health conditions, and expanding services to provide early intervention, assessment and diagnosis, person centered treatment planning, evidenced based practices, peer support services for primary and behavioral health care needs of individuals with substance use disorders. The overarching goal of Iowa’s Integration Project is to improve primary and behavioral health outcomes for the special population of focus, individuals with substance use disorders. Iowa PIPBHC will accomplish this through four primary goals: 1. Promote integrated health care services through a bidirectional model utilizing an Integrated Care Team approach. 2. To support the improvement of integrated health care services provided to individuals with SUD, SMI and co-occurring health conditions. 3. To increase the number of integrated health care services provided to individuals with SUD, SMI and co-occurring health conditions. 4. Implement an innovative and comprehensive care team approach between the Iowa Army National Guard (IAANG) and col-located substance use/mental health community providers. Iowa will provide services to 175 unduplicated individuals annually, 875 over the project period. Iowa's population of focus will provide the services by the ICT annually to an estimated 127 individuals who identify as White, 25 who identify as African American, 7 who identify as Asian, 1 who identify as Native American, two individuals who identify as Multi-Racial, and 13 who identify in the Other Race category. Significant majority (101 clients) of persons served will be female compared to males (62 clients).

Grantee: AREA SUBSTANCE ABUSE COUNCIL, INC.
Program: GBHI
City: CEDAR RAPIDS
State: IA
Grant Award Number: 5 H79 TI080490-02
Congressional District: 1
FY 2019 Funding: $400,000
Project Period: 2018/09/30 – 2023/09/29

The proposed project, Stabilizing Homeless to Achieve Recovery Project (SHARP) is specifically designed to assess, assist, stabilize, and monitor homeless persons and families with SUD and COD (Co-Occurring disorder) to access and achieve permanent housing status. This project will involve each of the three intended activities identified in the FOA: 1) behavioral health and other recovery-oriented services; 2) coordination of housing and services that support the implementation and/or enhance the long-term sustainability of integrated community systems that provide permanent housing and supportive services to the target population; and 3) efforts to engage and connect patients who experience SUDs or CODs to enrollment resources for health insurance, Medicaid, and mainstream benefits programs (e.g. Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI), Temporary Assistance for Needy Families (TANF), etc.) Area Substance Abuse Council (ASAC) is Iowa's largest substance use disorder treatment and prevention provider, serving five counties in eastern Iowa. ASAC operates primary residential, outpatient, and transitional housing treatment services. ASAC also operates two permanent housing projects: The Way Home LLC and ND Housing LLC. The agency has established relationships with other permanent housing providers across eastern Iowa. While many of the necessary individual services for successful recovery (i.e. housing, substance use disorder and mental health treatment, employment training/assistance, healthcare, childcare, etc.) are available within our communities, point of contact coordination of those services is needed. SHARP will formalize and enhance the process for assessing service and housing needs, will assist in removing access barriers, will coordinate service provision and utilization, and will provide ongoing monitoring and support for participants. Similar to traditional case management services, the Housing Navigators proposed under this project will work directly with SHARP participants to reduce repeat incidents of homelessness, to stabilize them in permanent housing, to increase Recovery Capital, to facilitate/monitor access to and utilization of treatment and mainstream resources and to increase employment and income levels. The Primary Goals and Objectives of SHARP are: Goal 1: Reduce homelessness among individuals (including youth) who experience homelessness and have SUDs or CODs, and/or families who experience homelessness with one or more family members that have an SUD or COD. Objective: 75% of SHARP participants will secure permanent housing and maintain housing at follow-up as measured by living situation on the GRPA intake assessment and GRPA follow-up assessment. Objective: 75% of SHARP participants will state that their housing situation has improved as measured by client satisfaction surveys. Goal 2. Increase access, utilization and coordination of appropriate treatment services to homeless who have SUDs or CODs, and/or families who experience homelessness with one or more family members that have an SUD or COD to improve health and well-being of clients. Objective: 75% of SHARP Participants will remain engaged and/or complete recommended Care Plan services as measured by project evaluation. Objective: SHARP participants will decrease their substance use by 50% as measured by GRPA intake and follow-up questions about substance use. Objective: SHARP Participants will increase Assessment of Recovery Capital (ARC) by 25% from project enter to follow-up as measured by ARC at intake and at follow-up. Goal 3: Increase access, utilization and coordination of appropriate mainstream and wrap around support services to homeless who have SUDs or CODs, and/or families who experience homelessness with one or more family members that have an SUD or COD. Objective: 100% of SHARP participants will be provided assistance in finding permanent housing as measured by Housing Navigator tracking data.

Grantee: PRIMARY HEALTH CARE, INC.
Program: GBHI
City: Des Moines
State: IA
Grant Award Number: 5 H79 TI080466-02
Congressional District: 3
FY 2019 Funding: $400,000
Project Period: 2018/09/30 – 2023/09/29

The Polk County Integrated Housing and Health Service Program for Homeless Individuals project will provide support for 400 individuals in Central Iowa who experience homelessness and have substance use disorders (SUDs) or co-occurring mental and substance abuse disorders (CODs). The project will provide a comprehensive system of integrated services to support placement in permanent housing. Primary Health Care, Inc. (PHC), a Federally Qualified Health Center and Health Care for the Homeless provider, will lead the project in collaboration with Central Iowa Shelter & Services and Prelude Behavioral Services, and will build on the successful county-wide Centralized Intake system to provide increased access to permanent housing, behavioral health services, and other supportive services for individuals and families experiencing homelessness. This project will help clients improve their quality of life and achieve self-sufficiency by supporting them in their efforts to maintain recovery from mental health and substance use disorders. The project will utilize the Critical Time Intervention (CTI) model to provide emotional and practical support during the transition to stable housing. Grant funds will be used to hire four full-time CTI Workers to help clients find housing and link them to supports, including primary care, mental health care, substance abuse counseling, and other services. This project will use evidence-based protocols and engage an extensive network of providers to ensure clients have access to a full continuum of services. Grant funds will also be used to hire a full-time Outreach Therapist (CADC/LISW) and a full-time Peer Recovery Support Specialist. An additional full-time volunteer Peer Recovery Support Specialist will support this project. Project goals and objectives include: increasing the number of clients who obtain and maintain permanent housing; enrolling clients in benefits; screening and referring clients to mental health and substance abuse services; providing clients with supportive services that improve their chances at long-term housing and recovery; and establishing care for clients’ physical health. The project’s progress toward achieving goals will be monitored by a Steering Committee and an experienced evaluator will oversee data collection and analysis.