She’s Threatening Suicide Unless I Let Her Come Home and Use 

Suzy231’s daughter is lashing out at her, and threatening suicide unless she gets her way. Setting boundaries in such situations could hardly be more difficult, but it’s necessary all the same. Just as important, however, is looking for help from professionals trained to intervene in such cases.  

Hello. I have a 20-year-old adult daughter who has really hit new lows in her addiction in the past few months. I had to call the police on her in early March because she was threatening suicide because I would not allow her to have a friend here at our house. She got very angry with me. They held her for about 13 hours, just enough time to start withdrawal. She is mostly addicted to fentanyl but also uses weed, meth, and probably anything else she can get her hands on. She left the house March 4th and has come here about three times since, sometimes to spend the night and gather more stuff, but mostly she has been out and around sleeping in motels or cars. She is extremely angry and blames me for absolutely everything in her life that is going wrong. She insists the drugs are what actually makes her happy.  

About 12 days ago she left with God knows who to San Francisco, which is two hours away, and said she was going to have this great life and her own room, etc. Knowing better and knowing there was nothing I could do, I advised against being so far away, but I knew I could not stop her. The past few days things have not been going well and she wants me to pick her up and let her come home and use in her room, and then maybe she can get happy, and once that happens then maybe she can get sober.  

If I do not do this, she tells me she is going to kill herself. She will send a thread of 100 to 200 texts at a time with pictures of a knife. Then she will say a friend found her but she will get away from them and succeed next time. She has contacted me, her dad, brother, sister, and a good friend, and we are all exhausted and just over the threats. Basically she tells me that I’d rather put my foot down on stupid rules than have my daughter live. She expected me to drive up there to save her—if I cared I would drop everything. I do not feel safe being alone with her knowing the drugs she is using and the vulgar, angry texts we are receiving. She is convinced her family has thrown her away and we would rather her dead and do not love her. She tells me I’ve been emotionally abusive when I’ve spent the past 15 months trying so hard to help her. Last summer she was doing better but that didn’t last too long.  

Anyways I have been doing my best to work on myself. I have a therapist and have listened to all the Coming up for Air podcasts and am doing my best to implement them. But I know I fail often in the heat of the moment. Today she is on her third promise to be dead by tomorrow in the past two days. I have been ignoring the horrible texts because it’s all just putting me down and telling me how horrible I’ve been to her and how when they find her dead I’m the reason. It’s very hard because I have always been there for her. While I am hoping this is pure manipulation, I’m not sure what else to do or say. I told her earlier that I am not going to respond to threats, but she just keeps going at it.  

Hoping you can give me some advice. We know she cannot come home and have told her that, and that she needs a program. She seems to think using is all that is making her happy, but in reality she is vile and just mean. I want my baby girl back.  

Thank you. 

Hello Suzy231. Your situation sounds exhausting. Your daughter is essentially running the streets in San Francisco and is sending desperate texts in droves to family members about wanting to kill herself. You appear to be the main target of these emails because your daughter sees you as the primary go-to person for her pain and frustration. Moms and dads are the fixers, the protectors, the holders of resources. So that incoming barrage is intense and very personal. How awful to be getting such messages. 

I can feel the direct hits from these dark, angry texts. They are meant to get you to do something. Your daughter is hurting. Is she suicidal? We can’t say. You are living in terror because you can’t say either. And the thought of it is unbearable. 

I hear you: you want your baby girl back. Let’s see if we can back up a little and suggest some options.  

Boundaries are for you both 

We recorded a podcast this week with your situation partly in mind. Setting boundaries for yourself may well have the effect of shifting your Loved One’s hardened position. This is what you are already doing by not letting your daughter come home to live with you. Each time it is raised, it’s simply not an option, and you defend the boundary.  

The other way boundaries can help is by shifting responsibility back onto her. A boundary is a space between two people. Can you set a boundary that protects you as well as your daughter?  

Your boundary might be: “Here is what I am willing to do when my daughter sends a scary text.” Or you could work it the other way: “Here’s what I won’t do.” An example might go something like this: If and when my daughter pushes me to do something for her by talking of suicide, I will take action and explain to her what I can provide as relief.  

There are many options for help. Choose one and reach out. 

What follows are four action options to start with. 

Option 1: You can call in for wellness checks, whereby the police are asked to check on your daughter (you did this once; consider doing it again). 

Can you see calling the police and requesting wellness checks as often as needed? This only works if you know where she is, I realize, and only if you can trust the police to treat her well. If you’re not white, inviting the police is a trickier proposition, and the decision harder to make. Calling the police sends a strong message to your daughter that she is being taken seriously and that professionals are stepping in. Calling for a wellness check can also demonstrate that you are not the solution.  

As her mom, this is an action you can take that deflects the responsibility for your daughter and her needs away from you and onto professionals. Your daughter sounds very complicated—too complicated for you to be making decisions based on texts. You can’t know for certain what she’s experiencing, and you don’t have the same ability to weigh it all as someone more experienced.  

I know you’ve thought about what else you can do for her in these scary moments, but there are limits. And the most serious limit is this: you cannot swoop in and save her from her destructive behaviors. You can get and stay connected with her, partner with her to provide options, and generally be supportive of any movement on her part to limit the drugs or seek help.  

Option 2: In my estimation, nothing is going to get better for your daughter until she is able to walk away from the fentanyl. Fortunately with opioids there are drugs that your daughter can take that immediately substitute for the fentanyl in her body. I am talking about Medication Assisted Treatment (MAT), more specifically Medication for Opioid Use Disorder Treatment (MOUD) (We love acronyms in our field). 

Having spent over 10 years addicted to opioids, I can tell you the withdrawals and cravings are fierce. As an old timer, I am so distraught by these newer opioids—ten times, a hundred times stronger than heroin. I cannot imagine the power of the withdrawals and the habits our Loved Ones are enduring. Getting on methadone or Suboxone removes both the craving and the withdrawals very quickly. Right now, her decision making begins and ends with her drug supply. MAT creates an opening in the day for your daughter to be free of her physical dependency. It’s a huge first step, and one I don’t see bypassing given the strength of fentanyl.  

I see many MAT providers listed in the San Francisco Bay area. You can also use this locator system a pharmaceutical company put together to help locate ( in treatment supplement). Look for MAT providers that have referring or on-site psychotherapy, and other case management services. You may want to look at Module 8 for tips on how to make that request for your daughter to get on MAT.

Option 3. I suggest you prepare for a civil commitment, if that’s available in your jurisdiction. Obtaining a commitment is not easy. It takes time, and you have to compile evidence. You will likely be asked to show proof that your daughter is ill (medical and treatment admission records), examples of failed treatment, and why she is at risk of harming herself or others. The texts you’ve been receiving are examples of this very thing. Keep the dossier up to date and be ready to go to the courts.  

State hospitals have serious limitations for our Loved Ones, who often come in with addiction and mental illness, and where the treatment of both is usually limited to stabilizing and discharging. A hospital could put her on MAT though. A civil commitment can signal to your daughter the severity of what is going. It is also a break in the action for her, getting her away from the streets and in front of professionals who can diagnose the underlying mental health issues that are fueling the addiction. 

From the California Department of State Hospitals website: 

People who come to a California state hospital through a civil commitment are individuals who require physically secure 24-hour care that is not available through community programs. They have been found by the court to be a danger to themselves or others, or unable to provide for their own basic needs because of a mental illness. 

In California the process by which someone is civilly committed to a state hospital is described in the Lanterman-Petris-Short Act. The act requires that the person being committed is a danger to himself or others for successive periods of time and that a judicial review is conducted. 

Our treatment program provides services for adults who have been civilly committed or voluntarily committed by a guardian. Patients each have an individual treatment care plan and attend the treatment mall every weekday. The primary focus of treatment mall programs is to prepare patients to return to the community. Groups help patients learn how to manage their symptoms and medications, develop coping and recreational skills, budget and manage their money, and plan and prepare meals. Community reintegration is the focus of group trips to community settings. Separate programs provide educational support, psychotherapy and help for alcohol and drug abuse.  

The civil commitment treatment program has units at Department of State Hospitals-Napa in Northern California, and at Department of State Hospitals-Metropolitan in Norwalk in Southern California. 

Option 4: We’ve seen success for other families with a child in the streets by creating an open door to treatment in their location. We had a mom a couple of years back whose daughter was in a very similar situation to yours. We helped her find an inpatient treatment program for women and trauma in the city where the young woman was running. When the daughter contacted Mom, Mom had a short script prepared that explained how her daughter, when ready to get off the streets, could just walk into this program.  

Finding the program was the hard part, really. Your daughter will have moments on the street when she is scared and sick of her life. Providing a safe alternative works. You may find our treatment finding methodology  helpful in the search for such a program.      

Can you imagine a future where she comes home? 

Finally: while your boundary is that she can’t come home, can you foresee a time where she might be let home? Even temporarily? Something like what we describe with our concept of the daybed and locker? 

Your daughter wants to come home. It would be a huge reward if she could come home. Can you consider having her home when she is making an effort—perhaps after a good start, such as getting on MAT? It’s a little on the bribe side of things, but can you see having her home if she were trying to work on her recovery? If so, you should clearly tell her the terms. Something like: Once you’re on MAT and are interested in trying some recovery activities, we would love to have you home. Let’s get there together.