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He’s on Suboxone and Hiding Away for Most of the Day. We are Worried.

Her son was using heroin, and he just got out of jail. He reached out for mom’s help and asked to live at home as he starts recovery, and he is getting MAT (Medication Assisted Treatment), specifically Suboxone. But he’s secluding himself so much at home she can’t tell what he’s up to. He’s accessing counseling and groups remotely, but he stays holed up in his room all the time and rarely emerges. Mom worries about his isolating so much and whether he might be using. We weigh in with some thoughts about the varied aspects of early recovery, and with some reminders about practicing CRAFT (Community Reinforcement and Family Training.)

“Thank you for allowing me to join this Allies in Recovery group during these challenging times for all of us. My 33-year-old heroin addict son, who spent 90 days in jail, asked to come home for shelter and help entering a Suboxone MAT Program. It took about 10 days to navigate the process; intake, assessment, counseling and appointment with a physician. His stepdad and I live out in the country 11 miles from town, which I believe has been beneficial, but his decision to not use while awaiting MAT has been his alone. (By the way, his MAT program is also an hour and a half away as our county has no MAT programs.) He has been on the program now for three weeks and attending bi-weekly group counseling, weekly one-on-one counseling and has had two doctor appointments for Suboxone re-fill prescriptions. Everything now of course since the pandemic is by telephone which I am truly grateful.

All this maybe sounds wonderful, but he has self-isolated in the guest room. He stays in bed all day and all night as far as I can tell. He only comes out to use the bathroom, to get something to eat (mostly at night) and to make required telephone calls for behavioral health care. We are worried about his isolating and we don’t know what he’s up to.”

[This question was originally posed on the member site “Pose a Question” blog]

Welcome to this community. We’re glad you’re here. You helped your son get on Suboxone, a medication for opioid treatment. He is home, but also on wait lists for residential programs. You are questioning his behavior, which mainly involves hiding in his room.

Things indeed got more complicated by the COVID situation. In some ways they are easier and in other ways they are more difficult. You are grateful the trips into town for the clinic have stopped. Your son is newly on Suboxone but is now being seen (almost) entirely by telephone.

Suboxone is a good start for him, but doesn’t address other needs

Suboxone is a partial opioid (agonist) that keeps away physical opioid withdrawals. The other part of the drug is a blocker (antagonist) that prevents the person from feeling the high of an additional opioid. Together, the agonist/antagonist reduces the craving for opioids.

So Suboxone is an excellent start, but it doesn’t address the mental/emotional/ social/ spiritual needs of your son. I feel for your son. It sounds like he doesn’t know what to do with himself. Group and one-on-one therapy, now online, is important and he gets that through the Suboxone clinic. Is he liking it?

Figuring out whether he is using or if it’s just lack of interest in life

You’ve gone through the possibility that your son is using but you don’t see how he could be given the distance from town and the lack of transportation.

From your comment, it doesn’t sound like he is using opioids. It does sound like he has nothing in his life that holds even the most remote interest to him. That happens with all drugs, but especially with opioids (and stimulants) that cause such tremendous spikes in the reward center that anything else in life pales and holds absolutely no interest.

None of this is certain, but your son is being seen by a clinic who is following his use. So, I suggest you drop your search for a clear answer, and act like he is not using given the situation you’ve described.


Is it depression? Can you help him make some calls?

If he is not using, then what is going on? I would be concerned for his mental health, especially depression. Has he struggled with this before? Is he the type who sleeps when depressed?

If your son is dropping daily calls he needs to make to get on wait lists to residential treatment, you’ll need to pick this up. He will be forced out of his room in a treatment center. More will be available to him that will challenge him in a treatment center.

Help him understand being home is transitional

You have no reason to change his setup in your home, but keep in mind the cot and locker idea we describe as a possible way to communicate to him the transitional nature of your home.

I hope I’ve given you some ideas in this. Really, though, he is safe, likely abstinent, and has started treatment. I can’t stress enough how much any appreciation for life falls away when consumed in the world of drugs. Stopping the drugs doesn’t make life happen or the person any more inherently appreciative. The rewards come from trying new things and having them feel good.

Emotional and physiological recovery

He’s coming out of a stint in jail, is in a pretty different environment at your house than whatever else he’d been accustomed to, and he is in the midst of all the mental-emotional and physiological processes that go along with early recovery. It’s hard to express how much turmoil this can create. You’ve provided a place for him to land, at his request, and you are keeping a respectful distance.

But he’s ultimately not conformable being really present around you right now. That’s the message. He’s probably having a hard time being present with himself. This is part of how he’s coping with the pain and other hard feelings he’s experiencing. He’s hiding away. But he’s not angry or confrontational. Coming out of jail, addressing his heroin use, he’s got some big emotions to grapple with. He likely doesn’t feel too hot about himself, to say the least. His internal landscape is under major construction right now. It’s a raw time and it’s safe to say that very few have inherent, adequate tools to work through this easily.

Counseling and doctors’ appointments

The counseling and the doctors’ appointments are important parts of his process. It’s encouraging that he has these. Your compassionate support and your willingness to be there for him when he does need you is huge, whether he’s able to acknowledge this right now or not. For now I’d bide my time, trying not to jump to conclusions, but making sure not to let things slip through the cracks, such as the calls to get him in line for residential treatment (again, if you need to take over with this, go ahead). Keep things light, so the focus is not on following up on or nagging about tasks he needs to complete (calls, etc). So you assess your son to be using or not using, and then try to put the question out of your mind for the time being. Tomorrow, or even later that same day, you may need to revisit/ reassess. Try your best not to carry around a constant questioning about his status – that is just too exhausting.


Want him to be more open? Work on your CRAFT skills

You want him to be more open with you, and for him to be around more in your own home. It will take some time. As you practice patience with that, keep your focus on what you can do. Keep learning from the site, and practicing CRAFT when you can. I’d especially revisit the eLearning Module 4 on communication, “How Do I Talk to my Loved One?”. Some of the strategies we go into detail there include:

*stopping negative talk;

*using assertive talk;

*watch for change talk;

*using the “7 Keys to Positive Communication”:

  1. Show compassion and let them know you heard them;
  2. Admit your part;
  3. Be specific (when making a request);
  4. Be brief;
  5. Be positive;
  6. Use “I” statements instead of “you” statements;
  7. Offer to help.

In our eLearning Module 4, we go into detail on each of these, using examples tailored to a substance use situation.

Also, a key element in communication is using Reflective Listening. In fact it’s one of the core tenets of doing CRAFT well. Using reflective listening, you will summarize what you heard, with no judgment, no additions, no analysis, no attitude. We have touched on how to do this in some other public blog posts.

It sounds like you’re doing a great job of offering him support and even-keeled conversation, while not pushing him either. That’s not easy, but he probably appreciates the space. Try to find small rewards or gestures that show him your love and care, offer them when you have the opportunity, and gently step back. All of these are essential CRAFT strategies.

A CRAFT-inspired suggestion for what to say – and keep it light:

When the time feels right, perhaps you say, “I’m so glad you’re home. I know you prefer to be alone, but I’d love to be spending some more time with you when you’re ready. I know what you’re going through is hard. I’m here for you. And I’m proud of you.” and leave it at that. Keep it nice and light. Make this just about the connection between you and him: about your willingness to be there for him. If you get no response, so be it. Take it as a cue to refocus on something that helps you feel grounded, peaceful, and happy. And try again the next time as you see fit.

Your son is lucky to have you and his stepdad. Keep on doing what you’re doing. It’s hard not to have your son in your life the way he could be. Let this site provide you with the support you will need in the weeks ahead.



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