Treatment, Relapse, now Jail

Allies in Recovery member and mother has asked for guidance about her daughter whose heroin addiction is wreaking havoc. She has been to treatment several times, and relapsed just as many times. Now she’s in jail. What should the next steps be for this mother?

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“My daughter is 22 and has been using heroin for about 5 years. She’s been in and out of treatment. Her last plea to us was to do a 30 day treatment program and come home to an outpatient setting, to which we agreed. She did ok for about 3 weeks, then started staying out late and hanging with some unknown people to us.

Next she took our car and didn’t return for over 24 hrs. We reported to our local authorities that our vehicle was taken with out permission and so she was arrested for taking the vehicle and a 7 degree possession charge. I went to see her in jail to find out what her plan of change was but she was very angry and blames us for her arrests. She says she doesn’t want our help. I told her we needed to have a plan in place but she wants no part of it.  I don’t know where to go with this?”

This mother feels lost, Dominique Simon-Levine guides her to action

Well, you sure are in the thick of it…does it help to hear that what you are experiencing is not unusual?

You’ve succeeded in getting your daughter to treatment several times over. That is a testament to your relationship with her and to some motivation on her part to address her addiction.

All of this may make you want to give up on treatment. Please don’t. In one study of treatment, it took 4 treatment episodes on average to get any traction into sobriety. It’s hard to do, but every new treatment episode should be looked on as a new day…it has the chance of working; your daughter is in a new place, she may listen and be more willing; it is a break in the action and gives her body and mind a pause; and it is what you can do and stands the best chance of her recovering.

You did the right thing

Right now she is in jail. I commend your courage in calling the police when she stole the car. It is a hard consequence to be arrested for doing something illegal but it is a natural consequence. By calling the police you protected her from driving under the influence. You helped create the contrast in her world between use and non-use and made the message clear: use and face negative consequences. You didn’t mitigate those consequences for her, possibly emboldening her to steal the car again, to drive under the influence, or something worse. She is feeling the full weight of her actions. We don’t know what is going to shift her thinking. As the family, what you can do is facilitate natural consequences when there is use, or get out of the way when a negative consequence happens. Conversely, when there is no use, you can create a reward or support rewards as they come.

She is understandably angry at you. You are the easy target. It is likely you now have the criminal justice system working with you; by this I mean she will be assigned a case manager who will work on a release plan that includes treatment and housing, the court could mandate her to treatment, she could be given probation with drug testing. She turned up the heat on herself, and you may have a new partner in your effort to help your daughter.

Now it’s time to make a plan…

In case some or all of this doesn’t happen, we suggest you figure out a treatment plan for her. What has worked? 12-step or not-12 step-based treatment? Has she been on buprenorphine (brand name suboxone) or methadone? This on its own may not be sufficient but it is a critical starting point. In the Ludlow (MA) jail where I work, we are providing buprenorphine to inmates just prior to release.

I suggest you come up with the treatment plan. She is in no shape to figure it out. Come up with a detailed plan that has a couple of options if possible. Is she coming home to live? If she has been living at home these past years, the plan should include sober living after the initial treatment. The longer the treatment, the better the outcome is likely to be. If living at home has been a way for her to escape treatment, consider telling her she can’t come home until she has 6 months or more clean time. We’ve written posts about living at home (see the “Home as a reward” tab)

Stand back some from her. Let her be angry. Don’t jump in with the solutions. Give her the treatment plan if you see the jail isn’t doing it. Let her start to take responsibility for what comes next. Give her the space to start advocating for herself. She is not new to treatment and so has been taught how to get and maintain sobriety. She knows what is possible. It’s not like you’re dealing with someone who has never been to treatment and is clueless.

…and step away a bit

As her parents, provide her the resources she needs to take the next right step, but step away from her some. Let her feel more alone. Don’t go far away but try not to push on her either. You have the opportunity to change your stance with her. Let her know through your actions that you are no longer in her pocket.

Your daughter is in danger of leaving jail and immediately getting high and overdosing. The most likely time for overdose is upon leaving jail or treatment, when the body’s tolerance for the opioid has dropped. Please make sure you are trained and have on hand narcan, the overdose antidote. Here again, you can’t realistically chase after her, running behind, protecting her from herself. As the family, you can be prepared, informed, and willing to partner with her to help with treatment. The rest is up to her.

Don’t forget about your own well-being

Lastly, you must be exhausted. As you step back some from your daughter, replace the time with a focus on yourselves, on each other, on what can feed you. Watch Learning Module 7, available to members (view an excerpt here) to learn how to better handle your worry and anger. A large part of the work CRAFT asks families to do is finding ways to locate even a little peace in the midst of these crises.

Our thoughts are with you.

Since 2003, Allies in Recovery has addressed substance abuse in families by providing a method for the family to change the conversation about addiction. We use Community Reinforcement & Family Training (CRAFT), a proven approach that helps the family unblock and advance the relationship towards sobriety and recovery and to engage a loved one into treatment. Learn about member benefits by following this link.