Our Strategy Is No Longer Working
Mothra is trying to do the right thing, encouraging her son to seek treatment, but the situation keeps getting flipped and she ends up feeling used and helpless…
"Hello AIR – we are in big trouble here. Our son has been using heroin, cocaine, fentanyl, and any and all drugs available to him. This has been going on for over 20 years, with the occasional brief periods of non-use. Too many detoxes to count, multiple failed relationships, most often with another addict, have caused him to always be in a crisis of some sort. We do not allow him to live with us, but let him come here when he's hopeful and trying to get clean, giving him a place to arrange detox from. This has helped him in the past, getting him a month or a few weeks of clean time. Lately it seems he's been using trying to get into detox as a way to get into the house for rest or food or safety (hiding from girlfriend, police or bad guys) and more recently stealing from us. All the little scams and larcenies are adding up. Fines and court dates abound, usually ignored unless we push him to deal with things, like constantly reminding him of court dates, fines due, etc. He recently used my husband's car in a crime, which is being investigated. We are horrified and afraid for him. The last couple of times he's come here, he's been somewhat surly with us, as though we disgust HIM. I've often thought of section 35, and have missed a couple of opportunities to go through with it. Also I'm a little unsure of the process.
Today he called saying his girlfriend was crazy, he had to get away from her, and would Dad meet him at a gas station so he could get gas and then he'd come home and try to get into detox. We do not give money. On the way here, he managed to turn off the road home and was gone for several hours. This is not the first time he's done this. When he came in this evening I think he feigned making calls to detox, there's signs he used in the house; said he was tired and wanted to sleep and would call detox again in the morning and was going to bed, and quietly slipped out. Once more he got something he wanted and took off. He may try to return or we won't hear from him for a while until he gets desperate again. We feel used and helpless. We try to reward his wanting to seek help by letting him come here to make his calls to detox, have the list ready for him, but now he's abusing that. It's time to Section him I think but we need guidance. He will say he was trying to get a bed somewhere and we betrayed him. He's a physical and mental mess and worse than ever. I pray for jail and can't believe he's not been picked up by police. Our lives and our health, indeed our whole family, suffer from his addiction. We know we are probably making a lot of mistakes but don't want to turn away from him, and don't want him to feel abandoned by us. Any help is appreciated. Thank you."
The whole family suffers immensely when someone is struggling, as your son is. It is hard to imagine 20 years of a child misusing drugs and the family constantly shifting between moments of hope, drama, and crises.
You are already doing a lot of what CRAFT recommends. Making your home available to your son only when he shows willingness to get help, and only long enough to get into treatment. Providing the list of treatment. Being careful not to give him money.
I want to thank you for sticking by your son. Many people would not. You have figured out strategies that have worked, that got him into treatment, but it just didn’t last. He relapsed.
Remove rewards if they are being misused or diverted
It sounds as though he has now started taking advantage of your home. He is getting high in your house, stealing from you, probably enjoying a warm bed and food while high. He’s not really interested in going into treatment. He just knows that this is what he needs to say to get through the door.
So then perhaps the door no longer opens.
This could be the consequence of taking advantage of you. You could meet him at a diner with the cell phone and the treatment list next time he shows some willingness to get help. Buy him dinner while you're there.
His petty crimes are adding up. He must be becoming known to the court. Something will soon break the camel’s back. As much as we disagree with jailing individuals in need of treatment, I too will pray for jail if that's where he can get it. Jails are becoming the place to get treatment. It won’t be a comfortable detox but the jail will give him some medication to help with withdrawals. The courts are looking to mandate people to treatment.
If he does end up sentenced to jail, he will get some treatment and should get help as he is released back into the community.
MAT is a good first step for someone who's used this long
You didn’t write about this but I would think your son has had experience with MAT (medication assisted treatment: methadone or buprenorphine). Getting on one of these medications would reduce his dangerous behavior. He wouldn’t constantly be facing a terrible withdrawal. It is the fear of withdrawal that drives your son to behave in these terrible ways.
Rather than detox, I’d rather see him steered towards MAT to start. He probably needs much more than just MAT, but starting with MAT is critical. Of the two, methadone has more structure, requiring daily supervised dosing.
If methadone isn’t on your list, can you add it? What time does the clinic do intakes? What insurance does it take? What is the cost out of pocket? How is it going to be paid for? How is he going to get there every day?
He’ll say he needs a car and gas. He tricked you out of the last tank of gas. What if you purchased an Uber to get him to and from the clinic for the first month. His car is essentially parked, with no more money for gas. Anyway, that’s the idea. All the barriers to treatment should be figured out as best as possible by you, and detailed on the list.
To section or not to section?
The length of your son’s drug use and the increasing risk to himself and to others does make a civil commitment something worth looking into. Given the trouble your son is in with criminal justice, being civilly committed may be the best place for him “to hide out.” You could tell your son you are putting a section 35 into the mix.
Section 35 provides access to treatment centers in a timely manner. This isn’t always possible when the family is trying on their own to get the door to treatment open during a brief window when a Loved One shows willingness. The tabs to the right of this post include one on sectioning. The Massachusetts page (under News & Resources) provides more details about the process.
This site teaches families The Stance they should take when faced with a Loved One’s addiction. It is scientifically derived. It isn’t a guarantee that everything will work out but is the best position a family can take. It is a hard line to walk. You have been walking this line. You have engaged your son into treatment and seen him stay off drugs for brief periods. You are doing what you can do. You are reaching out to this site for additional help. The eLearning on this site will help sharpen your skills at this Stance.
In the meantime, your son’s world is getting tougher. Your description gives us an idea of how his life is tightening around him. He must be terribly tired. Keep your stance, stay connected to him, don’t give up on treatment, and look into a civil commitment.
Your son may complain of feeling abandoned but he is certainly not being abandoned by you. Take the needed distance from him when he is acting badly towards you. By knowing you are doing all that you can do, I hope you can find even a small bit of peace in your day.
Our son is in a TSS affiliated with the organization that runs the detox he was at. I’m grateful he’s in a safe place, just for now.
He is so foggy, he just called and didn’t even know if he was in a CSS or TSS; sadly I feel he will not get the clinical services for his mental health that he needs. He is very depressed. I thought the process was detox, CSS, then TSS while you wait for a halfway house.
Yesterday I was told all the TSS’s were full; but after I made some noise and calls he was suddenly placed, but not where I knew there were CSS beds. I don’t feel the caseworker put in a lot of effort; and I wonder if she actually SAW how ill he is, mentally and physically. I know these folks are overworked.
As I said, I’m glad he’s safe for tonight, but I think of TSS’s as a warehouse or holding point; that’s been our experience in the past. This is all in the Danvers/Tewksbury area. Anyone have any experience with this issue? Thanks.
When TSSs were funded probably 20 years ago now, regional providers wrote proposals for Massachusetts state funding that included varying levels of programming. Some funded TSSs were heavily programmed, with a good deal of structure for their clients. Others were designed more as holding facilities, with much less structure. TSSs are transitional by design, set up to hold individuals until a residential bed becomes available. So, yes, what you get can vary. Is there anyone reading this that can provide more information about the evolution of TSSs or their Loved One’s experience in a TSS?
As someone who managed a TSS years ago, and has been directing a residential facility for the past decade or so, perhaps I can offer some additional insight. First of all, bear in mind that the State bureaucracy (DPH, DMH) still distinguishes between those services that focus primarily on substance use disorder issues (Detox, CSS, TSS largely contracted by DPH) and those that focus primarily on mental health disorder issues (Crisis Hotlines, Respite’s, Psychiatric units in Hospitals – those with DMH affiliation). Years ago, the CSS/TSS structure grew in response to a situation where people were leaving detox with no available follow up care facilities, and limited availability at long term residential facilities.
As Mothra writes: “sadly I feel he will not get the clinical services for his mental health that he needs.” Bear in mind that “clinical services” for mental health needs are sadly lacking, particularly at the publically funded level, and that the burden falls on Case Managers in the Substance use realm who often lack training/certification in mental health arenas, to attend to these issues initially.
What does this mean? If someone’s “primary” diagnosis is of a mental health nature, and they are also substance users, they often begin in “treatment” for medically necessary reasons that all too often are not focused on significant and chronic mental health disorders that demand treatment protocols and medication reviews and follow-ups. At the TSS/CSS levels of care, the focus is medical stabilization, and assistance accessing the long term residential environment.
Things have been changing over the years, and now long term residential programs are required to staff with Clinical Supervisors – a level of staffing still not required for TSS levels, but present in CSS levels. This means that a recognition of the intertwinement of substance use/mental health is accepted and attended to much more directly these days. But you can see where Mothra’s confusion comes from… Her son is apparently at a level of care whose focus is residential placement, NOT necessarily mental health adjustment. One can’t complain of a plumber not attenting to electrical problems, though as a homeowner, both are important.
Parents/the public often fail to understand the particular purpose of each separate level of care, and assume that each level provides all things to all people. We are not there yet, but staff at each level do the best they can to provide integrated care to everyone they deal with.
Finally, I have always had a negative reaction to “Holdings”. It reminds me of the meat-locker scene from “Rocky” with sides of beef being held prior to being distributed. Every contracted CSS/TSS is required to provide Case Management and psycho-educational programming. This is not the equivalent of pyschiatric oversight or long term therapy. But, by their very nature, people can only access these units for limited periods of time – “Stabilization”. Hope this helps explain the situation a bit better.
Thank you 25C so much for that clear and precise explanation, and your honesty. I thought I understood the system somewhat better than most, but this recent experience was one of the worst, and we’ve been going through this for 20 plus years. As far as his mental health, we are not sure if it is primary or the result of his addiction. I’m sure it’s obvious to anyone with addiction experience who meets him that he would most benefit from long-term residential care; it’s just not been available when needed.
My son was placed from detox to a TSS in Tewksbury. Although I did inform the detox caseworker of his mental health issues, found an available bed in a CSS with a good reputation and gave the contact email and telephone of the placement coordinator there, it is my opinion that she did the easier thing and placed him in the TSS affiliated with the detox facility.
During his brief stay in TSS, his “stabilization” consisted of waiting the first 2 days for a nicotine patch, and a medical profile taken from a woman who lost the paperwork and had to repeat the intake the next day. He was at least given his antidepressant, probably because he brought it in with him. The rest of his time was spent chasing caseworkers who promised him a list of halfway houses and access to unit phones to call them “in just a second.” He never got the list nor phone access, nor further access to a caseworker. The meat-locker/holding tank description fits.
He was able to call us collect via a payphone on the unit, at $30 per call through a for-profit system called CTL. We made a plan that we would call halfway houses/sober homes, find out availability and pass the info on to him next time he called. We estimate we have been charged over $200 total for the calls. He has been in a couple of TSS’s/CSS’s in the past but nothing like this. And, yes, I know he was trying to wear us down, but we weren’t going to help him unless he had a place to go, so I believe he was trying. Catch 22.
Frustrated, sick and angry, he packed up to leave the TSS and that’s when he was given access to a phone. He found a halfway house from our list who accepted him and he called me. He could just as easily have chosen to call a friend and use. I picked him up and drove him to the halfway house. Awful experience but potentially good result, but ONLY with family help. Don’t know if he’ll make it this time; but we will be there if he doesn’t and will keep trying, wiser.
Mothra (who finally had a good night’s sleep!)
Thank you so much for your response. He did show up again day before yesterday after alarming self harm statements via text. Then texted again that he didn’t mean it and was ready for detox. Sobbing, shaking and crashing from cocaine. At this point he is using whatever drug is available, though heroin is first choice. We let him in, had the list ready and this time he made the calls. He is in detox now. I’m not sure of his mental status at this time. He is so far out of whack. He has a history of anxiety, deep depression, ADHD, PTSD.
He has tried methadone and hated it, refusing to take it ever again plus it often makes him ill. He sells his suboxone, and his anti anxiety meds. Keeps only his antidepressant but is so busy chasing drugs he doesn’t see the MD for refills so its not consistent. ADHD meds sold so MD won’t prescribe them anymore. Just goes to different doctors to work the system. I do believe MAT is the way to go but I think it will have to be closely supervised under long term treatment of some kind.
Lost a friend to overdose 2 weeks ago and is blaming himself because he “should have been there to save him.” Girlfriend is an active addict and they feed off each other. The young man who died was her brother.
Nevertheless I’m going to do my due diligence and we will be ready to section next time. He is getting worse – out of control and scared of himself – and you are right – the judicial system is closing in.
Thanks for directing me to info on section 35. I am torn up with worry and fear all the time. I will never give up on him, but Sectioning seems to be where we are if he doesn’t go to a long term treatment program after this detox. Thank you and bless you for your help.