His partner is trying to moderate her use of heroin and methamphetamine with no formal support. Her 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. Read on for suggested strategies from AlliesinRecovery.net to engage his partner into treatment, using the CRAFT (Community Reinforcement and Family Training) approach.
“I’m having a hard time figuring out when to disengage/engage. My partner is convinced her best hope for recovery from heroin (11 years addicted) is through moderating her use with no other treatment.
She seems genuinely convinced that she’s doing better and is 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 and slow-down of her use is her best chance at 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 (methamphetamine), she is generally always using. When she is not, she has a bad case of formication (where you hallucinate the feeling of insects, crawling in, on or underneath your skin) that has her staring at a mirror in the bathroom, working on (picking at) her skin for 4+ hours a day.”
[This question first appeared on our member Q&A blog at AlliesinRecovery.net]
Your partner is using heroin and methamphetamine around the clock. She is, however, trying to moderate her heroin use. You live together but she hangs out at her dealer’s when she feels like it. She has lived at the dealers house over the years – it is a place where she feels comfortable. It sounds like you are worried if you press her about substance use, she will simply go stay with her dealer.
There are moments when you can see that your loved one is using less, appears less high, and in these times, you feel more comfortable stepping in and engaging with her.
Formication is the sensation that bugs are crawling over and under your skin. It is a side effect of stimulant use, not its withdrawal. Behavior involving uncontrollable picking at one’s face also happens with both stimulants and heroin. It is not necessarily a result of feeling bugs crawling on your skin, but users who are withdrawing from heroin can experience a sensation of “crawling out of their skin”. In this case, users may use skin picking as a way to find relief from the side effects and drug cravings associated with detoxing from heroin. Skin picking can also provide a temporary release from their anxiety and restlessness.
Moderation has been studied primarily with alcohol
We talk about moderation in our AlliesinRecovery.net eLearning CRAFT Module 1, where we offer a case study and references. The study of moderation is quite limited to alcohol; it has not been studied with many other drugs. However, harm reduction, used to decrease the negative consequences of recreational drug use by offering education and supplies to promote safer use and reducing frequency of use, can be seen as an effort to moderate.
Moderation is one strategy individuals use to try to quit alcohol and other substances. In this way it is worth supporting the idea at least for a while. In the very least, it is an acknowledgment by the loved one that there is a need for change and work to be done toward recovery. The individual soon learns whether they are capable of this supreme level of self-control.
Your partner is in a very difficult place
Your partner moves from heroin to methamphetamines as a means to moderate her use. It is hard to imagine that using methamphetamines as a substitute for heroin is a winning strategy, yet she has been using this strategy for 18 months. I’d say this is plenty of time to have learned whether this method works. She is still fashioning her day around drug use, whether it be heroin or meth.
It is a horrible place to be: trying to slow down use thereby knowing acknowledging it is a problem and needs to end, but not being able to stop. It kills the high. It encourages self-hatred. Your poor loved one. The relief, if any, is absolutely fleeting. She is unwilling to let go of the drugs, yet this partially successful lower level of use feels even worse. The war in her head, in her soul, and against herself must be incredibly overwhelming and never-ending.
Strengthening the bridge between you while speaking up about her use
She is asking you for 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 this leaves you with two options: to agree and be positive, or to disagree and be negative. You know that being negative will drive a greater wedge between the two of you, but you desire to strengthen the bridge between you. At the same time, you want space to express feelings and thoughts from your perspective. Feeling forced into checking one box or another, so to speak, doesn’t leave room for you to feel heard.
Try a CRAFT script to make small but crucial shifts in your communication and encouraging the message of treatment
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 open to hear. The more you can think about the framework of your conversation and partnership, the better. This takes a lot of patience and practice but allows more space in your communications to get your message across while empowering her with your empathy. Ultimately, it paves the way for the steps your loved one needs to take toward treatment. For example, 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 X hours in the bathroom yesterday using methamphetamine (time it to be accurate, of course). The face picking has become worse. Your world has become so small. I am overwhelmingly sad at times, scared to the point I can barely 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 methamphetamines? I read up on moderating, and it says to succeed you need to be working with someone, a professional who will support your journey. Here is the name of someone I found. What do you say we call and make an appointment? If you don’t like this person, we’ll find someone else.
We can get you to your goal of moderating by adding in this person. Thank you for listening.”
Whether she hears you and responds to 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. Try to lean on the information you have and maintaining an open, calm, and compassionate manner.
Have Narcan on hand just in case
One final thought. You should be trained and have Narcan on hand in case your partner overdoses at home. For instance, if she ever appears unresponsive and won’t answer the bathroom door or 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 multiple tries. We have other ideas should this first one not work.
UPDATE: Our member wrote in and shared that our CRAFT strategy worked. His partner is now taking engaged in methadone treatment. It’s certainly a start. We write more about what happened next in another blog post on our member site.