I Fear Pushing Him Back to Heroin

This post originally appeared on our Member Site blog, where experts respond to members’ questions and concerns. To sign up for our special offer and benefit from the Allies in Recovery eLearning program, click here.

“First of all, I would like to say I am very thankful for the Allies in Recovery site. It has helped us with our 23-year-old son so much. I appreciate all the hard work Dominique and the other members have done to make this such a great resource.

In December of 2017, our son went into inpatient treatment for heroin addiction. He is currently going to outpatient treatment and sometimes sees a therapist and psychiatrist. He is also a regular cannabis smoker and has been diagnosed with depression and PTSD. We aren’t trying to get him to quit marijuana, as it seems to be the lesser of two evils.

There’s one thing that concerns me

Sometimes, he is very motivated to work, get more education, and go to therapy. At other times, he is extremely tired, and just wants to stay in his room, play video games and watch TV. I’m unsure if it’s his depression, the marijuana use, or something else. I just worry that if I push him too hard, the stress will cause him to turn back to heroin. But if I don’t push him hard enough, I’m worried that will also hinder him in becoming an independent adult. Any guidance would be greatly appreciated. Thanks again for providing such a great site for moms like me.”

Dominique Simon-Levine reassures this mother that her strategy is exactly what CRAFT would suggest

I am very glad to hear your son accepted and completed treatment for heroin addiction. He is currently abstinent from the heroin but you are concerned about his marijuana use. You have furthermore chosen not to address the marijuana as it is the lesser of two evils.

CRAFT researchers at the University of New Mexico suggest just the strategy you have taken:  addressing the more pressing and dangerous drug first. In your case, the family applies the behavioral and communication strategies specifically to heroin, and “allows” the pot use.

We’ve written elsewhere about marijuana use, how strong the drug is in its current form, and how it dampens motivation, in a sense making the person a passive observer of their own life.

Time to address the depression

On the flip side, a little marijuana can help with depression; a lot, however, tends to aggravate depression. Getting the depression treated is therefore important. On our member site, we list cognitive behavioral therapy (CBT) in our list of evidence-based resources. Your son is experiencing important life changes. Acceptance and commitment therapy (ACT) may also speak to him. With ACT, the person articulates values that are essential to him/her and works to align day-to-day behaviors with those values. Since he is showing ambivalence for things he does value, like work and therapy­—sometimes on, sometimes not—clarifying the behaviors that align with those values may help tip the balance, and lower marijuana use.

Your son is 23. You worry that pushing him to stop the marijuana might upset his early recovery from heroin. You are also concerned that he may be getting stuck in place, unwilling or unable to step out fully into his own life. It’s been over 9 months since he stopped the heroin.

So, yes, the pot may be leading him to choose bedroom and video games over work and therapy. I’m not sure what his relationship is with his therapist. But could you find a group or individual therapist trained in ACT or CBT as fallback?

Recognizing a change in motivation

I suggest you look at Learning Module 8 (available on our member site) and prepare yourself for a talk around the kitchen table during a sober moment, perhaps when your son has articulated a wish or a dip: perhaps a specific desire for more than life is currently providing, or a dip, a low moment in which he complains of feeling down or feeling stuck. As we suggest in this Module, script out the talk in which you’ll suggest the addition of more treatment…

“…I am so proud of you for everything you are doing to address the heroin problem. I can’t tell you enough how much calmer I feel, how much my life has changed knowing you are safe. In thinking about what’s next, I’d like to see you (get your own place, go back to school, work in your chosen career …..). There’s an expert I found that can help you better address your depression and occasional lack of motivation. It’s been over 9 months. I hope you agree, it’s time for the next step.

I wonder if together we can think through how your dad (other?) and I can help you. What would you like to try first? If you can tell us what you need next, we’ll try to help. I don’t want to be involved in the details so much, so we’d like you to pair this with going to talk with the expert. How does all this sound to you…”

If he pushes you away, thank him for listening. Tell him you’ll talk about this again soon. Find another time and be ready to roll out the script again.

Keep up the CRAFT

In the meantime, doing CRAFT on your son to address the pot use is unlikely to cause him to return to heroin. Start with the behaviors of Learning Modules 5 and 6 (the full Modules are available to our members. View an excerpt from Module 5 here.) Step away when you see him high (likely after a period locked in his room playing video games), step in and reward when you believe him not to be stoned. It’s gentle and positive. Are there things you can do together, that your son likes, that get him out of the bedroom?

Your instincts have been good

Your son is responding. He is showing greater interest in his life, and your influence can help bring him to the next level. As responsibility for himself expands, his use of pot should decrease. It is definitely an easier drug to reduce from than the heroin. To start, let’s see if any of these suggestions helps lower the amount he uses.

I always feel like apologizing at this point, since I am very aware of all the work and heartache you have already been through, and here I am suggesting a whole new campaign! Remember to keep watch over your own emotions and stress going forward. Let us know how this works.

Illustration © Eleanor Davis