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She’s Trying to Moderate Use on Her Own But I Don’t See it Working

Worry-woman with mug

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.



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. Have seen mixed results and not sure the best way to proceed but frustration and exhaustion are really high on both ends.

    On Tuesday she went to the ER for an abscess on her leg. She talked about how disappointed she was in herself and how it felt like a setback and how she wanted to make sure this didn’t happen again. I took this as a dip and saw an opportunity to bring up additional treatment. I thought I’d wait till the next day to talk about it.

    Treatment itself has been mixed, she has missed about half the days getting methadone and had her dosage stopped because she wasn’t doing what they require new patients to the program to do. What was happening was she was spending 8+ hours a day at her dealer’s, coming home late and continuing to use meth until 5am and unable to wake up to get things done. Methadone did give her back her mornings and make it so she wasn’t so desperate to secure her next fix. She did too after having the dosage be stopped get determined to do everything she needs (blood tests, group orientations).

    Meanwhile her use of both heroin and meth have stayed pretty much the same, combined with her spending more and more time at her dealer’s, not coming home at night and the formication problem is the same. She has also been taking my car (no driver’s license) In general her life is still 100% revolving around her use.

    It feels like she Uses her being in treatment as a get out of jail free card for everything else. Like you can’t be upset with me because I’m doing methadone.

    She also has no cell phone so she uses either my phone to call her dealers or my computer to call her dealers. I’ve put passwords on them both, stopped giving her rides, made sure she doesn’t take my car. The methadone clinic is 8 blocks away, she can easily walk there and I offered to get her a bus pass but she hasn’t made that any kind of priority.

    I feel like I am policing her and she is telling me I’m being controlling, acting like her parent (I’m her boyfriend ) and being harder on her since she started treatment. My original thinking was accepting of the fact she physically still needs to use but if I made it easier for her to go and get it, she could spend more time on other things. Instead she just spends more and more time at her dealers.

    I told her I am not here to make it easier to score drugs, I am here for anything else. I had a list of different options she could do outside the methadone clinic hoping to help with meth use. But things rapidly blew up and all the good will she was showing was just to get money out of me.

    I just don’t know what to do, how much I need to disengage from assisting in anyway of her drugs and how much to allow the methadone to work. She went right back to everything she was doing after the ER and with her only making 50% of her doses, hoe much time I give this current oath.

    My instincts tell me to back off, show a lot of love and let her know she needs to prioritize getting her dose and working toward not needing any more heroin. That it’s her treatment and things will move at her pace. That I’m here with a lot of different ideas she can try adding and things to help with the meth use when she’s ready. Then giving her some time.

    How long is reasonable for someone to get to the point where methadone is enough where they don’t need to use at the same time?

    This website, your responses, the podcasts, Smart recovery for family and friends and having intermittent FMLA set up have been everything to help me.

    Thanks again

    1. Your girlfriend has started methadone yet she was not going everyday. A doctor will start dosing with methadone and will continue to raise the dose until the person stops craving. The spottiness of her attendance at the methadone clinic probably made it difficult to follow their usual guidelines. Once the methadone dose is right, she should stop using the heroin. This can take weeks. Since they are working with her again, and she has redoubled her efforts since the leg abscess, the heroin use should drop. Things should start to level out very soon.

      The methadone clinic should be seeing the methamphetamine in her urine toxicology tests and addressing this as well, to the degree they can. They can talk to her about it, they can refer her to additional treatment, they can leverage her using the methadone. Read Dominique Simon-Levine’s full response to pthasnohead here:

    2. In the last few years, the focus on Medication Assisted Treatment protocols in the treatment of addiction has resulted in much confusion. It may stem from our society’s overall desire to seek a “silver bullet” solution to an extremely complex problem. As someone who has worked in the Addiction treatment world for close to two decades, I have witnessed the paradigm shifts that have infulenced approaches to helping people overcome their attachment to substances as a means of dealing with the twists and turns of life. Methadone, suboxone, vivitrol … these are pharmaceutical tools to assist people with cravings and help them move through the withdrawal stages of dependency. Without the use of appropriate psycho-therapy to supplement the bio-chemical interventions, no medication in an of itself will remove the underlying desire to find quick relief from life’s demands. This is frustrating for people who often expect immediate results in people who are being prescribed all sorts of medications. I am attaching a valuable article that I have given people to look at over the years, and I hope it helps you here. The primary message is that everyone needs to understand that no pill/strip/dose is sufficient. Necessary at times, but not sufficient. Addiction is a problem rooted in perception – the idea that some substance relieves the user from the pain associated with being in the world. Until that pain is confronted, accepted, and finally dealt with through long term commitment to practicing new ways of behaving, thinking and feeling – no real substantive change can take root.

  2. I am so glad to hear how well you have embraced the AIR and CRAFT approach. As a mom I know how important maintaining lines of communication are.

    Can I ask why your daughter chose to go the methadone route? Has she been in an IOP before? Does she have access to other medication assisted treatments like Vivitrol or Sublocade? I completely understand that you don’t want to apply pressure but she did try the methadone option in the past so a new approach might be something to consider.

  3. Thank’s to AIR, Craft and the podcasts, My LO is starting treatment.
    However, it is the last option I would have chosen.
    My last post I talked about not knowing when to disengange/engange with her constant use/formication.
    The advice I was given worked great, things definitely got worse before they got better like discussed on the most recent podcast.

    So treatment, yay! big step. However, she chose to start methadone treatment at a clinic she has been to 3 or so times in the past. Because of her tolerance/years using, the expectation is that she will continue to use until her MG dosage goes up and she stabalizes. She expects to need to go up 60mg or so and they increase it by 5 every 5 days if you ask. That’s a year. Meanwhile all the bad behaviors continue, that are damaging to her and to me. She still spends all her free time at her drug dealers house and the Meth use seem to get worse.

    I am trying to be positive and happy she is starting treatment but this feels like something to get me off her back. I am getting a lot of “I started treatment like you wanted me to, you need to have reasonable expectations” She is just beginning and hasn’t started with a counselor or going to any group classes or anything. I am also very much not invited to be a part of her treatment.

    I am just not sure how to act when she is just starting treatment but the use/behaviours are still there?

    I think what I would like to do is give it a little time, trust the process and the doctors and hope it gets her some momemntum to want to quit. But it is really hard when I am looking around and wondering whats changed?

    Last time I wrote about her saying she was moderating her use and the advice I was given on how to respond to that worked really well. I think I would like to modify that with the message of time to consider other treatment.

    I also really want to talk to her about her continuing to live here but not sure if it’s the right time since she is starting treatment.

    I probably just need to sit back and be patient but I am currently feeling pretty overwhelmed with how far she has to go and how long it’s going to take.

    1. She started methadone but your daughter’s bad and dangerous behaviors continue. Let’s first applaud your success in using CRAFT to get your daughter to enter treatment. Hurray!

      I wish that getting her into treatment provided you with a much needed break. It still may. Methadone does take a little time to stabilize in a person. Typically, a person starts at 30mls and goes up from there. It is possible for her to get up to 60 much quicker than the outline you have been given.

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

  4. Thank you for the detailed, thoughtful response and help. I found those suggestions on how to communicate with her to already be very helpful.

    I wrote that at a time when I hadn’t heard from her in 5 days and was feeling pretty low and losing hope for her.

    When she came home she opened up voluntarily about her use, how tired of it all she is, how if her from 10 years ago saw what she has gotten used to and normalized would be shocking. How great it will be once that stuff and her dealer no longer have power over her.

    With the help of having a plan on how to communicate and all the ground work that previous work using CRAFT methods I was able to use the opening of a dip to continue the conversation and talk about all different types of treatment options she may have.

    While it wasn’t her saying “I want treatment now”, this was still fairly groundbreaking and what felt like a big step.

    I always worry about what’s her motivation and if she is manipulating but I know she is exhausted from everything and there was not anything she was trying to get.

    She has a doctors appointment with her primary care physician in a month and a half to talk about treatment. This has been the deadline in my head before I take away the option of her living here.

    Small victories are great but it feels so fragile. At this point I am unsure if I should try to make her life more uncomfortable or give it a little time for her to get there on her own.

    My internal debate is whether or not to take away giving her rides, a car or bus money and a place to stay if she uses will help push her to wanting treatment or push her away. It seems pretty obvious on the surface but if I don’t she will either stay at her dealers with no contact.

    I do have Narcan in the house but that fear, especially when she cuts off contact can be petrifying. Feeling good about how to interact with her and feeling hopeful has also helped me with a renewed focus on self-care though.

    I’ll update later

    1. Wow, your daughter opening up is a huge step! I just wanted to mention that it is very possible that the primary care dr will not be very helpful. Can you write out a list of options, from 12-STEP or SMART RECOVERY meetings (both self-help), to counselors, to IOP to residential. The idea is to provide her with specific interventions, with specific phone numbers and addresses, and also to provide transportation. You can also offer to go with her as she explores options. This strategy, from this site, has been working for our family.