PThasnohead has been in a tough position with his Loved One trying to moderate her use with no formal support. The use consumes so much of his partner's life that it’s hard to see her “moderation” as progress. But his Loved One wants him to acknowledge how well she’s doing, and there hasn’t been room for more discussion.
I'm having a hard time figuring out when to disengage/engage.
My Loved One is convinced her best hope for recovery from Heroin (11 years addicted) is through moderating her use with no other treatment.
I think she seems genuinely convinced she is doing better and genuinely really proud of the progress she has made. I don't think it's a product of manipulation or control of the topic of her recovery. She just thinks a really elongated moderation slow down of her use is her best chance of recovery.
I don't see her building the skill-set and doing the things needed to make a long term recovery. She just has less access to use because she lost her job and doesn't have the cash she previously did.
Between needing to use to avoid being sick and using her other drug (Meth), She is generally always using. When she is not, she has a bad case of Formication that has her staring at a mirror in the bathroom, working on her skin for 4+ hours a day. Read the full comment here.
Your partner is using heroin and methamphetamine around the clock. She is, however, trying to moderate the heroin. You live together but she hangs out at her dealer’s when she feels like it. She has lived at the dealer’s over the years, it is a place where she is comfortable. It sounds like you are worried that if you press her about her use, she would just go stay at the dealer’s.
There are moments when you can see that your Loved One is using less, is less high, and you know that in these times you can step in and engage with her.
Formication is the sensation that bugs are crawling over and under your skin. It is the result of stimulant use, not its withdrawal. Picking your face also happens with both stimulants and heroin. It is not necessarily a result of feeling bugs crawling on your skin, and is not due to the withdrawal phase. So picking = use.
We talk about moderation in Learning Module 1. The study of moderation is limited to alcohol. It has not been studied with other drugs, though harm reduction (making use safer and reducing use) can be seen as an effort to moderate. Moderation is one strategy individuals use to try to quit a drug or alcohol. In this way it is worth supporting the idea for a while. It represents at least an acknowledgment that there is work to be done. The individual soon learns whether they are capable of this kind of supreme self-control. Your partner moves from heroin to methamphetamines as a way to moderate. It is hard to imagine that using meth as a substitute for heroin is a winning strategy.
Your Loved One has been using this strategy for 18 months. I’d say this is plenty of time to have learned whether it works. She is still fashioning her day around the drug use, whether it is heroin or meth.
It is a horrible place to be, trying to slow down use and thereby knowing it is a problem and needs to end, and not being able to end it. It kills the high. It encourages self-hatred. Your poor Loved One. The relief is fleeting. She is unwilling to let go of the drugs, yet this lower level of use, only partially successful, feels even worse. The war in her head and against herself must be never-ending.
She is asking for your acceptance of her strategy. She wants you to see “how well she is doing.” As you say, this puts you in a tough position. You feel like you have only two options: to be positive, and agree, or to be negative, and disagree. You know that being negative will drive a greater wedge between the two of you. You know you want to strengthen the bridge between you, and yet you want some space to express things from your perspective. Feeling forced into having to check off one box or another, so to speak, doesn’t leave room for you to feel heard in this.
This is the nitty-gritty of communicating with CRAFT. You practice making small shifts in what you say and how you say it. Eventually these shifts add up to a message about treatment that your Loved One is able to hear. The more you can think in terms of a framework of conversation and partnership, the better. This certainly takes a lot of patience and practice. But it can allow some more room in your communications, for her to feel your empathy while still allowing you space to get your message across. This paves the way for the needed steps your Loved One needs to take towards treatment. The next time she asks you to agree with how well she is doing….
“You are using less heroin, that is good. Thank you for trying so hard with this. I want to support any effort you make to stop using drugs. You spent 4 hours in the bathroom yesterday using meth (time it in order to be accurate). The face picking has gotten much worse. Your world has become so small. I am overwhelmingly sad at times. I am scared to the point I can’t even breathe. You’ve been stalled at this point for quite a while.
I am so proud of your efforts to moderate but it’s not entirely working. What else are you willing to try? How are you going to moderate the meth? I read up on moderating, and it says to succeed you need to be working with someone, a professional who will help you keep track. Here is the name of someone I found. What do you say we call and make an appointment? If you don’t like the person, we’ll find someone else.
I think we can get you to your goal of moderating by adding in this person. Thanks for listening.”
Whether she hears you and moves on this right away or not, this is the consistent message you are looking for. Next time she pulls you in and wants you to agree with how well her plan is working, say, “it’s not working as well as you say.” The key is not to engage in an argument about this. Try to lean on the information you have while maintaining an open, calm and compassionate manner.
One final thought. You should be trained and have Narcan on hand in case your partner overdoses at home. If she ever appears unresponsive, for instance, she won’t answer the bathroom door or won’t come out of the bathroom, consider calling in first responders. You cannot be charged with gauging your Loved One's safety on your own. Let the professionals in. You have been living this extreme situation for so long, the terrifying may be appearing more normal. Looking into the eyes of a first responder can be an intervention.
Keep using CRAFT. She is talking to you. You are enduring a very tough situation. Give yourself some credit for there being any bridge at all between you. This is something for you to work with and build on. Please write in and tell us whether the ideas we have laid out here help. Give it a couple tries. We have other ideas should this first one not work.