Photo credit: Lalesh Aldarwish
Substance use disorder often occurs alongside other physical and mental health challenges, making a tough situation much harder and more complex. As frends2end knows all too well, finding care that takes our Loved One’s whole condition into account is one of the hardest aspects of such situations. That makes it doubly important to know the best strategies and options out there. Allies’ Dominique Simon-Levine shares some of her discoveries.
My son is 35, still lives at home, and is an addict. In addition, he has deep depression, social anxiety, and is bipolar. He’s been on methadone for about five years now but I know he still uses. What I don’t know is how often. He has other health problems as well, and I think he is using to cover up the pain because doctors can’t seem to help him. He says he wants help, but due to his insurance limitations, we just have not been able to get him the right help.
I am out of my mind with worry that the help will never come. I feel like I have lost my son and I so desperately want him back. Don’t know where to turn.
This situation certainly does sound challenging. Your 35-year-old son lives at home. He’s occasionally still using drugs (opioids, I believe you mean) despite five years of being on methadone. His mental health is not good, and he suffers from social anxiety.
How to find him the right help?
Let me start by saying that social anxiety complicates everything for your son. It makes it hard to get out the door, I would guess, and to show up for appointments and other obligations.
In Alcoholics Anonymous, there’s a saying: “Meeting makers make it.” Over my years in AA, I saw how true that was. The friends I made were those who showed up, and I showed up for them in turn. Those who had trouble getting themselves to a meeting, or to a coffee date, fared worse.
I was a weird mixture: I had social anxiety, but also a little courage to walk into those rooms or to see a therapist. The fire under me to stay abstinent won out in the end, but those friends helped a lot. Making friends in a mutual aid group was probably the most important reason I stayed abstinent.
Social anxiety is linked to early trauma, so your son may need help for trauma as well. Here’s a Discussion Blog post I wrote a while back to the mom of a young man with social anxiety that was crippling his life.
I also want to tell you about the treatment research I did recently for a father on behalf of his 30-year-old son who, like your son, has a health condition and serious depression alongside an addiction (fentanyl, in his case).
But first, I’d like to quickly point out that periodic urine testing should have made your son’s methadone clinic aware of his opioid use. If a urine test comes back positive, a methadone clinic will consider increasing the dosage of methadone until the use is eliminated or at least much reduced. This could be happening with your son right now, even if you’re unaware of it.
CRAFT skills help us read the moment and respond effectively
For this reason, and to help you establish some foundational CRAFT skills, I’d like to suggest that you work your way through Module 3 (What’s Going On When My Loved One Uses?). The questions the module poses can help you build your awareness of when your son is high and when he is not. We have a drop-in skills hour at noon most days of the week that can help you work through these exercises if you like.
Let me emphasize that it’s important to have an educated guess as to whether your son is high or not in the moment. This helps you respond to him in the informed and effective ways CRAFT practitioners have developed through years of real-world experience. In terms of your son’s treatment, it will help you answer the question of how often your son is using opioids and whether the use is going up or down.
It’s important to recognize that your son is in active treatment, but that the methadone alone isn’t resolving the addiction or his health issues. The methadone is not keeping him abstinent, but likely low. Please be aware, however, that taking opioids on top of Methadone is very dangerous. Methadone is an agonist, which means it’s an active opioid. Your son will need to take more of the illicit opioids to override the daily methadone and FEEL high, leading to dangerous levels of opioids in his system.
The challenge of care for multiple conditions: a recent case
Unless you can afford private, tailored treatment, it’s hard to find treatment for individuals with complicated situations involving addiction, pain, medical and mental health needs. In
fact, I’m afraid it’s nearly impossible, within public or insurance-based systems of care, to have all your son’s needs met under one roof.
That dad I was working with asked the same question you’re asking: how to find treatment that would address his son’s mental health needs and fentanyl addiction. The son also badly needed physical rehab for an injured foot. He had not followed the aftercare plan after each surgery and was now walking with a walker and had gained over 100 pounds. The need for physical therapy, all by itself, ruled out all residential treatment in the state of New Hampshire. At the end of my search, I had found no residential addiction treatment program willing to take a young man in this shape. Nor were they willing to make any accommodations for him, like allowing a physical therapist on campus, or allowing him off campus every day to rehab his foot. The one exception was a hybrid program (private housing + outpatient treatment) that wasn’t handicapped accessible.
So, I went to work on another hybrid plan of sorts. His addiction to fentanyl was so very serious, as it is for millions of other opioid users in the United States. This ongoing public health emergency dictates the need for medications that stop the craving and withdrawals from opioids quickly. This young man had disliked his one experience with Suboxone treatment. I wanted to open methadone as an option. Trouble was, the closest clinic taking new clients was 50 miles away—too far for him to visit daily. There was one clinic closer ,but they were so understaffed that the waitlist was six months. The son would need to turn to other resources.
Here’s what I came up with: a weekly stay at a $90/night motel in a larger city nearby with many more resources. I found a solid opioid outpatient care clinic that offered detox and maintenance medication for opioid addictions. This gave the young man options. (In your case, your son would ask that his methadone dosing be transferred to such a clinic, where there is Suboxone and other addiction medications). I looked for an outpatient facility that had a partial hospital program (PHP), the most intense kind of outpatient experience. Once he completed that program, the young man could continue by stepping down to an IOP (Intensive Outpatient Program), thereby receiving four months of continuous care. The clinic also provided access to psychiatric care through a contract with a private psychiatrist. For his foot, I found a large hospital physical therapy program, also near the hotel.
Because he used a walker, the young man couldn’t manage public transportation, so he was going to need Uber-type transport to various clinics and mutual aid meetings. Dad’s ability to pay for those Ubers, and a $100/week grocery store card, completed the setup.
Monthly price tag: $2,700 hotel, $300 Uber, and $400 food (at Manchester, NH prices). I suggested the father ask for consent from his son to get the urine test results from the opioid clinic as a way to gauge his son’s progress. In no way were the results to be used punitively. All programs were in-network with his Obamacare-type insurance.
Is there a way to adapt this kind of hybrid approach for your son? His social anxiety certainly makes for an extra challenge; he would need courage to step into this altered
world. It would, though, get him out of the house and into temporary housing, and provide a web of treatments and community. He would be independent and have his own private hotel room.
What else is out there?
Another option for your son is a hospital-based specialty pain clinic that also addresses opioids. Insurance is unlikely to pay for it, or for much of it. Here’s the Mayo clinic’s 3 week program as an example.
A third but very expensive option is private addiction treatment that addresses physical conditions, pain, and wellness. I assessed Caron for the previous young man. They were prepared to address his addiction to opioids and to tailor his treatment team to include daily rehab for his foot, a nutritionist, and exercise. Monthly price tag: 45 days for $85,000 (at a campus in Pennsylvania). As a courtesy, they will file the paperwork with the insurance company, but insurance is again unlikely to pay for much.
The bottom line is that your son is in need of comprehensive care. For places like Caron and Mayo, it is worth talking to his insurance company to see if a case can be made for coverage. However difficult it is to make that case, it’s not out of the question, especially if your son has a history of emergency department admissions, addiction treatment programs that have “failed,” and medical and physical conditions in need of treatment.
So many of our Loved Ones are vulnerable in more ways than just addiction. I hope that by laying out the treatment plan options for another young man; I’ve offered you something helpful in figuring out the way forward for yours.
Please do keep us up to date on your situation. We’re here to help.