He May Not Be Ready to Address It All at Once

Member Stinkyvan1 has a son in active recovery from opioid use, but the son still uses pot on a daily basis. Should his family draw a hard line where the pot use is concerned—and if so, when? Dominique Simon-Levine reflects on the process of ending use of multiple drugs and advises a slow-and-steady approach that builds on progress already achieved.

I learned about 1.5 years ago that my son was using opiates. I found out after his friend of many years overdosed in my house. His friend survived and convinced my son to confess to me. He was in college and told me he didn’t use often. Behavior patterns when back at school proved otherwise. Grades slipping, running out of money, etc. He left school in October and agreed to see an addictionologist and receive counseling. 

Tried to get him on MAT, but he parroted the cultural belief that using MAT is no different and replaces one addiction for another. After Christmas he said he felt better and wanted to return to school. He was still using, causing upheaval with his younger sister. I hate to admit this, but we were glad that he returned to school. 

His use obviously worsened, and he abruptly asked to come home in March. I said yes, but that change would be a requirement. He smokes weed daily and has boasted to me about all the other substances he has tried. My condition for his return was that the opiates needed to go. I considered this harm reduction and put the weed, etc. issue aside. He has been seeing a counselor weekly and is on Suboxone.

I learned about CRAFT from the Partnership to End Addiction. I found your organization, joined, and worked on the modules. It has really been a lifesaver, and I feel my relationship with my son has already improved. 

I am thrilled that he is not taking oxycodone anymore, but he continues daily weed. I feel this is progress, but the suggestion is to reward when sober, and he rarely goes without as far as I can tell. I am hoping that your method will gradually lead to change there as well. Is this OK, or am I tacitly approving of his substance use? It feels like the right thing for now. 

Thoughts?

Thank you for writing in. It’s important that we all hear of your successes with CRAFT. You have been using CRAFT specifically to address your son’s oxycodone use. He is now seeing a counselor and taking Suboxone, a medication that reduces craving and blocks the high of opioids. Well done—and not easy to do.

Now for the weed. Your son is still using cannabis. You are questioning whether to address the cannabis with CRAFT or whether it is too soon. Perhaps you worry that focusing your CRAFT skills on the weed would somehow destabilize your son’s current abstinence with the oxycodone.

Multiple drugs are complicated. Your response should be clear and consistent.

When a Loved One is using multiple drugs, it can be very complicated to do CRAFT on the entirety of their use. Each drug comes with its own presentation, its own signs and effects. Each drug is perhaps used for different reasons: boredom vs. partying for example. Different drugs are used at different times and in different settings. This is what Module 3 is all about, helping you learn to observe and distinguish between your Loved One’s various behaviors (in this case, behaviors associated with each of the multiple drugs). The work of CRAFT is to build a contrast in your behavior and reactions between when your Loved One is using a particular drug and when they are not.

Behaviorism is tricky in the sense that the Loved One needs to make the connection between being high and the loss of family love, attention, interest, and rewards. You don’t say a word about the drug use, yet it becomes a feeling they cannot deny: When I come home high, Mom is monosyllabic, neutral, the house is dark, and she doesn’t stick around. Something different is happening with Mom. Where’s the screaming and the guilt trip about being high? Why isn’t she slamming a cold dinner down on the table? Your son will eventually begin to associate being high with no attention from Mom, and when not blasted on pot, with Mom stepping in and being all nice and attentive. Again, he doesn’t have to know why you are acting this way; it is the effects of your behavior that he will link to his being really high.

CRAFT suggests you step in and reward when there is no use in the moment, and step away, allow natural consequences, and remove those rewards when there is use. This is what you did in addressing the oxycodone: leveraging your home and family life, welcoming your son home with the condition that he get help, and being super supportive by reinforcing his non-use and his treatment.

He’s taking on something tough

Until now, you have let slide the cannabis use. Your son’s weed use may have gone up since stopping the oxycodone. This can happen when the drug of choice, opioids in his case, is no longer an option.

Having been on various medications for opioid use myself, I can tell you that the urge to get high doesn’t go away. The craving for an opioid goes way down, thank goodness, but not the strong habit of desperately needing to be high. I too tried rather unsuccessfully to substitute cannabis as the high when I was on methadone, Antabuse, and naltrexone. But the pot was a poor second best. At one point I even recall toying with the idea of snorting the little white fluff balls in the carpet, having just about convinced myself that those white specks could conceivably be something I dropped along the way that could get me high. Completely wild thinking, a delusion really. I was hell bent on simply getting high. It’s hard to imagine the power of the mind when caught in addiction.

Talk to your treatment providers

We are writing this response to you in May. Your son has been home and on Suboxone since March, just a couple months. Do you have consent from your son to talk with the therapist? How about the Suboxone provider?

If so, I would ask them about the cannabis use. My guess is that the therapist and Suboxone provider will just say to ignore the cannabis for a few more months as your son stabilizes on the Suboxone. Getting the opioid use treated, as you have succeeded in doing, begins your son’s exposure to the workings and lifestyle of recovery. In my over 15 years of work helping incarcerated opioid users transition back out to the community, it’s been my experience that Suboxone providers typically ignore other drugs in those first couple of months as they seek a dose that stops the opioid use. I would go so far as to say that these medication providers see their mandate as the opioids and not other drugs much at all. This can mean that the treatment providers will not address the cannabis even months down the road.

If you don’t have his consent to talk to the therapist or Suboxone provider, you’ll be the one deciding (with our help) what to do about the cannabis use. Writing in as you have done here to Allies in Recovery allows us to help you frame your situation in a CRAFT context. We provide the principle, and you have to assess what is right for your family, what is okay to try, and to what degree it is safe to do so. You know your son best.

Let me suggest a few things to think about as you make a decision concerning the pot use in the face of early abstinence from opioids.

First, a note about cannabis. Tolerance to THC, the active substance in cannabis, goes up very quickly, especially if you are dabbing. Dabbing is a way of smoking cannabis concentrates that are much higher in THC. So one question for you is how your son is ingesting the weed. The answer will give you some idea of the extent of his pot use.

An active response doesn’t always mean confrontation

You may worry that addressing the pot may somehow drive your son back to the oxycodone. This kind of reaction is not our experience. When you think of doing CRAFT in the face of active use, you seek to disengage, hold back on rewards, and allow natural consequences to occur. This can be done quietly, subtly.

Say your son comes through the door blasted on pot—it’s clear from his eyes and that little grin and giggle. Forget the dinner you were preparing, and pull back: “Hey, glad you’re home. Talk later.” Your son is left alone, at the door, to think perhaps about this strange new reaction from Mom. Do this a couple times, and he very well may start to link being high with the disappearance of family, dinner, normalcy.

Individuals who smoke pot regularly are not always very stoned. There are potentially many hours in the day between dosing when there is THC in the system and the individual is just maintaining and protecting themselves from withdrawal.

Perhaps you hold off on grand pronouncements or directives for now about the pot. Just respond in a CRAFT-aware manner (Module 6) when your son is visibly high on pot. When your son doesn’t look high, step in and reward (Module 5).

You’re going to be at this for awhile

Perhaps down the road, with more months of Suboxone and therapy under his belt—and after your well-placed, CRAFT-y responses when he’s high on THC—you sit down in a moment of calm and make a request that he not use pot in the house (see how to make this kind of request in Module 8). And if he crosses that boundary, you’ve just set and comes home visibly high, you simply do what you have been doing: step away, remove rewards, allow natural consequences. Your boundaries, your reactions, are what you have control over. Focusing on what you can control can help you be more thoughtful, strong, and clear in your responses.

Your son will benefit from embracing a recovery lifestyle. He isn’t there yet, but he’s closer. Taking Suboxone and seeing a therapist are huge first steps and provide a significant chance that he will move towards a full drug-free lifestyle. We’re suggesting you move slowly towards addressing the pot so as not create friction between you or attempting too much change too quickly. Your overall goal is to help your Loved One and your home become drug free, and you’re moving toward that goal step by step. Steady as she goes. All our best.

Dominique Simon-Levine