He May Be Near Rock Bottom — Do We Leave Him in This Hole?

An AlliesinRecovery.net member wrote in to our “Pose a Question” blog, giving an honest and clear picture of their situation with a loved one in denial who is mixing alcohol and cocaine, and who has suspected anxiety, depression, and undiagnosed PTSD. He gets help, shows promise, then he slips. He finished school, got a job and apartment, and then…got arrested, went to rehab, but was discharged for being uncooperative. Now he’s on the street with nothing. People around the family are saying not to let him come back home.

Read our surprising answer, informed by the CRAFT approach at Allies in Recovery.

This question originally appeared on our member site.

“My 34-year-old son is an alcoholic combined with a SUD using cocaine. He has never allowed psychiatric treatment but anxiety, depression and PTSD are a good guess. He is extremely resistant to allowing help in and blames me for a lot. He has been on and off to meetings and treatment.

Over the last 15 years I have probably been enabling. I’ve paid for lawyers, coerced him to enter rehabs, paid his bills, helped with college, bailed him out of jail, bought vehicles etc., all with the intention of getting him on the right path.

Recently, last April, he managed to graduate from college with his degree. He moved into a great neighborhood rental near his sister who tried to be of support. Got a new job in his degree area, got a kitten and a loan for a nice newer car. I wasn’t far away for support. 3 days after he got the job, he took his car and a duffel bag and left everything behind. We didn’t hear from him for weeks.

I then got a call from him last November from the emergency room. He was beaten up with slight concussion and contusions and black eyes. His newer car was impounded. Evidently he was living in a garage in the inner city.

We went to the hospital. They were going to discharge him even though he could barely walk.

He was very hostile to everyone. We took him home with the caveat he would go to rehab. Long and short of this he talked me into taking him back to get his belongings in the inner city, and…he never came back though I waited four hours in a parking lot. He had no phone, no job, no money, no ID, and no car – just the clothes in his back.

The next day he called from jail and was arrested for larceny. We didn’t automatically bail him out but insisted a rehab or program be set up and that he go to rehab before we could bail him out. It took a month before anyplace could get him in. He was very angry at me for letting him sit in jail for that long, for such a small bail.

We managed to get him into a sober living home. I paid for the first month and then the plan was residents were supposed to get a job and pay from there. The counselor there said he was rude, uncooperative, not participating; and after 30 days released him and dropped him at a shelter.

He called from the shelter, and I gave him phone numbers for area help centers and rehabs; I didn’t give him money. He has no money, no car, no job, no place to live or phone, but I think he somehow accessed his email at times. It’s cold out; everyone says to let him deal with this on his own, but he has nothing.

My question is: Should I just leave him to his own devices or email him my concern? My husband says, no, it will only open the door to manipulate me again and he needs to deal with the consequences of his actions. Your thoughts?”

The CRAFT approach would agree with these boundaries – but not with leaving him in a hole. Read on…

Allies in Recovery Director Dominique Simon-Levine takes the question and walks through part of our approach, and suggests some resources on our member site:

You have done so many things well over the years, including getting very smart about the jail system and leaving him there by not paying bail, while you found a recovery home for him. I am so impressed.

An important rule of thumb is no pit-stops. Each pit-stop represents an opportunity for relapse.

Thanks to you, we are all a little smarter about the reason we talk about avoiding pit-stops, on the way to, or in between, treatments. In our e-Learning CRAFT Module 8 (the modules are a key part of our program for all Allies in Recovery members) you can read about that. In segment five, particularly read “Unpacking the World of Treatment.”

A few of the take-aways from our “Unpacking the World of Treatment” module on the Allies in Recovery member site:

• Have a list of treatment options ready when you find an opening to discuss it (a “wish” or a “dip” – we outline these in the e-Learning CRAFT Module on communication), or script out a planned conversation (see our Key Observation Exercise #21 on the member site).
• Consider what your loved one is most likely to accept.
• Gather the treatment option information you need beforehand, including these considerations:
• Who exactly does my loved one ask for when they call (in the majority of cases, the provider is going to need to hear from your loved one)?
• When should my loved one call?
• What information will they need for the call?
• What is paid for by insurance; how will the rest be paid for?
• What are the waitlist times?
• How will my loved one get there?
• What are the criteria for admission (e.g., sober for a certain length of time)?
• What evidence does the program have that it works?
• What aftercare (e.g., assisted referrals to other treatment, phone help, etc.,) does the program offer?

Might he be using Methamphetamine too?

I am concerned your son may have started using methamphetamine. Cocaine users don’t go on runs that last for weeks. Cocaine is way too expensive to spend weeks on the run. In my experience, cocaine users don’t give up everything in a heartbeat quite like methamphetamine users do.

The alcohol complicates matters further, as the mixture of euphoria, energy, and smarts (when you combine the two) is particularly interesting to some stimulant users. (See our public blog post, “I Think I’m Ready to Ask Him to Leave”, which addresses this cocktail.)

We disagree with those who are telling you to let him deal with this on his own

Absolutely reach out. See our multiple blog posts and podcasts on texting, and search on our member site index for the topic: “Loved one far away.” Sounds like email is your best bet. It has been a long time since contact.

As you know, the problem is: where does he go when you convince him to come in from the cold.

Trust me, this is not what he wants for himself

Your son has had periods of less/non-use in his life. He managed to graduate from college. He does want more from life and you have to believe me when I tell you he’s in the depths of despair with his life. This is not what he wants for himself. He lives in an imaginary world when high, filled with euphoria, steady energy, and (grand) smarts. There are terrible periods of depression and anxiety as he comes down from days of using and tries to sleep. And when the drugs run out and he wakes from that little bit of fitful sleep, the shame engulfs him. He lays awake piecing together the days before and what’s gone or messed up.

As you stare at the ceiling or sky — despite knowing that drugs just may be the cause — your mind turns quickly to the most concrete, guaranteed solution to stop the extreme, pervasive depression and anxiety, and you seek more drugs.

Treatments for stimulant disorder are limited

Treatments for methamphetamine and other stimulants are limited. In our member site “What’s News” Blog we list one controversial approach that involves rewarding (!) stimulant users for non-use.

It takes time to recover from stimulant use disorder, more time than is typically allotted by rehabs. The mental distress has a very long tail, many months. It follows that a safe, long-term and drug-free place to live is needed, as are skills for daily living and earning income. Some form of exercise and meditation is likely to help overcome the long-term emotional tenderness that comes with withdrawal from these high-powered stimulants. For everyone who cares for the loved one, and for the loved one themself, methamphetamine is torturous.

CRAFT suggests you DON’T cut off communications with your loved one

CRAFT suggests you do not break off communication with your son. Cutting off his money, on the other hand, could very well help drive him back to treatment sooner. He is going to need a detox to start, for the alcohol (even if he says it’s not a problem, it will be the way to get him admitted to a detox – between us).

Then you need an inpatient program to get him to 30 days sober, which is often the requirement for sober living.

This is probably going to be a difficult sell, as it sounds you are getting push back. Your son may walk into a church/temple/mosque/etc, or a harm reduction program, or an addiction support group.

These can work just as well. Your son needs to tell somebody he wants help. Any of these, on their own, could also be sufficient to jump-start a recovery process.

Because it is winter, COVID, and stimulants though, I am recommending he come home for those 30 days if you cannot get an inpatient place to open for you. And only if you can get those living in the house to agree to some basic set of values/ground rules.

Recovery Houses are, by definition, overflowing with challenges

We can’t know what happened in your son’s recovery house. It’s easy to understand the very hard job a recovery house manager has, as well as other fellow residents, in keeping their home sane, quiet, and free from substances. Who came up with the idea of putting 10 people in early recovery from substances, who suffer from a range of other unrecognized challenges, co-morbidities, and deficits in daily living skills (and who also have potentially unrecognized talents and the hope for a better life for themselves) 2 to 3 to a room, and tell them all to live together in harmony?!

The daily structure in a recovery house is minimal. Residents go outside the house for help. Living in a recovery house therefore usually means availing yourself of a patchwork of outside community services they may find “useless,” have little energy or motivation for, while struggling with finding enough life force or hope to navigate the system on their own, let alone the bus.

I hope family members read this. Like grief, society has ideas about how long it should take for you to get back on your feet, again or for the first time. David Sheff makes that point so clear in his writings.

People who work in recovery living communities deserve a huge thanks. People who stick it out in recovery living communities also deserve tons of admiration and appreciation.

The loss of life force is real, painful, and slow to return.

Withdrawal: This researcher says the physical symptoms only play a minor role

On the subject of withdrawal, let me recall for you what Maia Szalavitz, author of Unbroken Brain, concludes about drug addiction being 90% or more psychological – the physical addiction plays but a minor role.

“It’s just that the physical symptoms aren’t the main problem. What makes drug withdrawal hard to take is the anxiety, the insomnia, and the sense of losing the only thing you have that makes life bearable and worth living […] It’s the mental and emotional symptoms — the learned connection between drugs and relief and between lack of drugs and pain — that matter.”

Here’s the rub. When it comes to stimulants, the addiction and withdrawal is 100% psychological. There is no physical addiction to stimulants. In that sense, the cycle in your loved one’s head and the consequences of their use look more like problems with gambling than a chemical addiction.

Remember that detoxification units are charged with addressing only physical withdrawal symptoms. If your loved one has ever been denied admission to a detoxification unit for stimulants, this is why.

There are a few bright spots: The West Coast has much more experience than the East Coast. There is much to learn about what does work and what doesn’t. Oregon, Washington, California are leading the nation in innovative approaches.

Treatments for methamphetamine and stimulant use disorder are coming to light

There are several promising treatments coming to light for methamphetamine use disorder and stimulant disorder more generally. One is based in behavioral modification as mentioned above and the other is a combination of the antidepressant bupropion and the injectable drug naltrexone. See this article from Drugfree.org about the combination (we originally posted this in our “What’s News” section of the Allies in Recovery member site).

You wrote: “We went to the hospital. They were going to discharge him even though he could barely walk.”

In a book by Laurie Loisel (Those Left Behind, Gallery of Readers Press, 2021), Dr. Ruth Potee, who runs an acute treatment center in Western Massachusetts and has become a national spokesperson on addiction, describes the difference in the emergency room response between two urgent admissions:

“Through one door an old man is wheeled in, complaining of chest pain. Turns out he is having a massive heart attack, likely due in part to a 2-pack a day cigarette habit and misuse of fast food. He is immediately hospitalized, given lifesaving treatment, and sent off to a rehabilitation center for 8 weeks. Through the second door a young woman, unconscious from an opioid overdose, arrives, carried by a friend. The young woman is revived with Narcan, evaluated by the crisis team, and discharged.”

There is a lot of room for improvement up and down the line. When your son is back in touch with you, and you see a window open (I suggest watching all our e-Learning CRAFT Modules again to brush up on your CRAFT skills, giving special attention to Module 8) and he is willing — even a little and perhaps only temporarily — to be admitted somewhere, tell him you will do all you can. You are already good at this.

You and your husband may not want to hear this, but the only place you may be able to find for your son is the one under your roof. Yes, I am suggesting you consider having him come home.

Stimulant users abuse their bodies terribly. I don’t know what shape your son is in physically, but the threat of COVID, in my opinion, further amps up the danger he’s in.

Stimulant users run off to binge, they don’t sneak the occasional line of coke into the basement, plop on the couch, and turn up the TV. The opposite might be a person drinking alcohol chronically who can chip away in secret, but with increasing regularity, by occasionally sneaking alcohol to the basement.

What I’m suggesting is a drug-free home environment, with a brief but critical set of shared values/boundaries.

For clarification on boundaries, see Laurie MacDougall’s 1st and 2nd post public blog posts. Laurie is an Allies in Recovery CRAFT trainer and an expert on boundaries!

For a deeper look at the differences between leverage, bribes, rewards and incentives, also see Laurie’s two blog posts on bribes, incentives, and positive reinforcement.

The shared values include your son having access to a few recovery activities. Can you imagine what that would look like? Do you think it’s possible?

Thank you again for writing in and for your love and continuing commitment to your son.

I wish you the best.  Please let us know how things go.

[1] Maia Szalavitz, Unbroken Brain: A Revolutionary New Way of Understanding Addiction, St. Martin’s Press (2016):33.