Expert: Jacqui - 1/4/2008

Question
I cannot believe the journey I've traveled to finally arrive at this website, typing these thoughts and questions to a complete stranger, but I am desperate and lost and it's time to do something besides worry and struggle to deal with this on my own.

I've been with my boyfriend for just over 4 years now.  His name is also Josh and he's now 25.  Josh was born to a heroin addicted mother who supposedly only takes methadone everyday now.  His dad smokes crack and always has.  When he was 6 years old, he demonstrated for a jury how to construct a crack-pipe in a custody case and was subsequently legally adopted by his grandparents.  All that to explain how deep his addiction runs.  His aunt and at least 2 other family members I know of have died from overdoses.

When I met him, he was just a marijuana smoker.  Or so I thought.  We dated for a year before I realized something more serious was going on.  I also knew he was eating a lot of pain pills, but for some reason I thought it was harmless.  He seemed to be doing it recreationally.  I don't smoke or do drugs of any kind and don't drink alcohol anymore because I thought it would be helpful for him to have a drug and alcohol free house.  But we were young and I thought it was normal to a certain extent for kids to smoke pot or in his case, pop pills to party and have a good time once in a while.  Coming up on a year, I discovered he was buying a pain pill called "dilaudid", diluting it with water, and shooting it up with a needle.  I freaked out and told him it had to stop.  He promised it would.  That went on for a few months as far as I know, but in retrospect, it's possible it was going on for much longer.  I decided to move to California and told him that if he wanted to stay with me, he would have to be clean from drugs of any kind before we drove out of town, or he couldn't come.  He got clean.

Once we got to California, he started popping pain pills again.  I caught him and kicked him out.  We were separated for 8 months until he begged me to get back together with him and promised that he'd grown up and things were better.  I loved him so much that I took him back on rather blind hope that he was telling the truth.

Things have never been worse.  I caught him shooting up heroin for the first time.  He's since told me he used to smoke heroin occasionally when he was a teenager.  We checked him into a methadone clinic where he took 100mg a day until we decided it wasn't working and that the methadone clinic was just a racket in business to make money off heroin addicts.  Maybe I was totally wrong about that, but he was paying them over $100 a month, was still pissing dirty when they checked him, and there didn't seem to be any repercussions.  He seemed to be able to dictate the terms of his methadone treatment however he wanted.  I don't understand that.  I thought this was a "program" that was supposed to help him get off drugs, not addict him to something else on top of his heroin.  So we checked him into a 12-day detox.  I wrote him a letter every night before bed and mailed it to him telling him how proud of him I was.  After 6 days, I called to check on him and they told me he wasn't there anymore.  According to him, his roommate who was also detoxing tried to escape through a window but then had a change of heart, so Josh put together sheets to make a rope to get him back into his bed, but was caught and told that it didn't matter what he was doing--he'd violated the rules and had to go.  So back home he came.  But he said he'd already been through the worst of the detox and was going to make it.  He seemed fine and we went through 2 glorious months of happiness and sobriety.  He met with a councilor every morning and talked with her.  Then his grandfather passed away.  He flew back to Flint, MI where he was picked up at the airport by him mom and relapsed immediately.  He stayed in Flint for almost 2 weeks and became completely dependent again.  He returned home a mess, but said he wanted to get right back to his councilor.  He was home for 4 days and his Grandmother (adopted mom) died.  He had to return to flint for the funeral and was there for another 2 weeks.  Now he's home again and he's worse than I've ever seen him.  He went back to his councilor and she put him on 30mg of methadone, which he says isn't enough.  According to him they filed paperwork to raise the dosage and now it's up to 40mg.  He says it's still not enough.  He takes the methadone every morning, then heads to downtown LA where he buys heroin and shoots up multiple times a day.  He lies to me almost every other sentence.  I don't know what to believe anymore and I don't understand addiction or how it works or whether any of the people who he sees are really trying to help him or not.  

In all the years I've been with him, I've never known him to steal anything, but he took money off my checkcard a week ago, and then stole money off my credit card 2 days ago.  I just figured it out when the fraud department called from the bank yesterday.  Last night his employer called me and told me that he was caught stealing a backpack of things from the job where he's been working and was fired.  He didn't come home last night, which is the first time in 4 years that has happened.

I seriously don't know what to do.  I don't know how to help him anymore and I don't know how to help myself.  We've fought and yelled and gone round and round the last few weeks.  He does nothing but cry and tells me that with the death of his grandparents, he has no one in the world left but me and that he'll kill himself if I walk away.  He says he thinks about dying everyday and that he cries every time he puts the needle in his vein, but can't stop.  He wants to check into a detox clinic again, but we have no money and apparently there are long waiting lists.  I don't know whether to call the police and have him arrested where he can come off the stuff, or keep him in the house for a day until he's really sick and then take him to the emergency room and beg for help.  I don't know whether he can come off the stuff on his own here at the house.  Is that dangerous?  Will he die?

I honest to god don't know what to do anymore or where to turn.  Does methadone work?  I've also read about suboxone.  Where can I get some and is it something we can administer to him ourselves?

In the interest of being completely thorough, I'm enclosing a letter that he wrote to me the day before yesterday so you can assess to the extent possible from a letter his state of mind as you interpret it....   here goes.

          (begin letter from him to me)


    Dear Josh,

I have so much running through my mind-so many thought, feelings...
    First and foremost I hate myself for hurting you, for involving you with all of this, stressing you out, worrying you, lying to you, hiding things from you, angering you - and worst of all, damaging the way you feel about me.
    Josh - THIS IS NOT ME!  I am not in the drivers seat.  I am not in control.  Josh, you KNOW ME.  The REAL ME.  The boy you fell in love love me.  That boy isn't gone Josh.  He's fighting hard, but losing.  Physically I'm a slave to this.  I have no choice or control over my actions - when my body screams for this I have to do what I have to do.
    You don't understand the pain.  It hurts so bad being sick.  There is absolutely nothing like it.  Your mind no longer has any say in the matter.  Josh, I can't make it clear enough how badly I DON'T want to be on drugs.  I hate it.  I hate doing them.  I hate myself every time I do them.  I cry in the bathroom every time I have to do it.  I hate going down into the dangerous ghetto and risking my life on a regular basis.  I hate spending money on it.  I HAVE no money to spend on it.  I LOATHE myself right now.  I am so humiliated and ashamed of myself.  I can't believe I've come full circle - I just went through this - and I was doing great!  My life was perfect!  Eating healthy, clean, looking good, getting lots of exercise, our relationship was great.  I was working hard and enrolled in school.
    Then - I went home to face the two most traumatic events possible for me back to back and I buckled.  I relapsed.
 It's nearly a month later, I'm back in California, and my program isn't working this time.  I need help and I can't do this on my own.  Josh...I want this so bad.  I can't live like this anymore.  I am not going to waste one more year of my life on drugs.  I know I can clean up.  I know I can and will stay clean as long as I'm not physically addicted to it and as long as I don't go back to Michigan.  I can and will do this.
   Baby, I am so so so sorry.  I hate that we're here again.  Josh, this is the last time.  I swear to god and on all that I know and love.  You deserve so much better than this.
    I am so lucky to have you and that you've stayed by my side.  Josh--I will be worth it.  I swear to god if I relapse again after this treatment, I will leave, but PLEASE OH PLEASE give me one more chance.  I won't let you down.
    When I get out, I'll be myself again.  I won't be my mother and I don't want to become my father.
    I love you...<Josh

        (end of letter)

I know you provide your thoughts and time for free and that is amazing.  I will be ever so grateful for any thoughts you can share with me.  I don't know how much more of this I can take but I'm worried that he's fragile right now and might hurt himself if I give up on him.

Sincerely,
Josh

Answer
Hi Josh,
You letter is so powerful, and you really seem at your wits end.  I have read it twice, and although it is extremely emotional, I think the best thing that I can do is answer your specific questions and hopefully they will do something to help.
Firstly, I must say that you are dealing with A LOT.  You obviously love your partner very much to have stood by him for so long.  Drug dependency at this level is very difficult and can have very hurtful effects on the lives of others.
So, to answer some of your specific questions -
1. Will he die if he does the detox at home?  Withdrawal from opiates can be very difficult, but people are unlikely to die from it (they may feel like they are going to though).  It is characterised by extreme discomfort in the limbs (a bit like restless legs that older people get), sweating, vomiting and diarrhoea, feeling cold and mood swings.  Obviously there is extreme craving as taking the drug makes all of this go away.  There are, however, some drugs where withdrawal can kill, and these are benzodiazepines and alcohol.  Benzos are things like Xanax, valium, etc, and withdrawal from huge amounts can cause people to have seizures.  So, my answer is slightly qualified, in that if he is only dependent on opiates (ie: heroin, dilaudid, etc) he could probably withdrawal safely (at least safely in a physical health sense) at home, but if he has been taking lots of other things, then he would need medical support.
2. 30 or 40mg of methadone is a fairly low dose if he has been using a lot.  There is some controversy about methadone as a treatment for opiate dependence as you do become dependent on the methadone.  In Australia (where I am writing this from) it is often seen as a means of reducing the harms associated with the heroin use rather than always ceasing use altogether.  For example, if someone goes from using five or six times a day without methadone, to using once a week with methadone, that is a success.  Many won't agree with this statement, but I do believe that if someone wants to stop using, then any reduction is an achievement.
4. I would not suggest calling the police.  There are drugs in prison, and if he does end up there, he may still use, and the risks of drug use in jail are huge (ie: sharing injecting equipment, risks associated with other inmates beating him up for drugs, overdose).  Also, prisons are awful places, so I would've wish prison on my worst enemy, let alone someone I love.  However, I do emphathise with your situation, and know that you must be really desperate to even consider this.
Now that your specific questions are answered, I need to emphasise that you are obviously a really strong person and must really love your partner.  As I have said in most of the answers I have provided in this forum, if I had an answer to "how do I stop using drugs" I would be a millionaire.  There is not absolute solution that will work for everyone.  From the information you have provided, it sounds like your partner has had a very difficult upbringing and it is not suprising that he has a drug dependency problem.  When a child is put through the stressors that he has gone through, the ability to trust others, relate emotionally to people and approach problems in a rational way, may be compromised (I must say though, that that isn't always the case - it is just more likely in these kinds of situations).  However, he must have a level of resiliance that has got him through so far, and something that keeps him going.  He wants to stop, which is great as it is very difficult for people to be forced to stop using drugs.  
Unfortunately, as I am in Australia, I am not familiar with services that are available in the US.  Given that his problems are relatively huge, he may benefit from a rehab, which is a longer term in-patient option, however I don't know whether there are public rehabs available (ie: ones that don't cost the world).  If that isn't possible, then raising his methadone dose, and re-engaging in counselling will possibily be a good option.
There is one more question that you asked, and probably the most important but difficult one to answer.  I do not know if your boyfriend will commit suicide if you leave him.  However, if that happens, then it would be his decision and you would be IN NO WAY RESPONSIBLE.  I know that this probably sounds terrible, and I really don't mean it to be, but it is true.  If you cannot cope with the situation any more then you need to put your own feelings above anything else at this point.  There is no point you staying with him if you don't want to.  
You are in a very diffcult situation Josh, and I really feel for you.  If you are prepared to continue to support your partner, then consider the methadone/counselling option.  I really wish I could give you an answer that would fix your problem, but I can't, and I don't think anyone can.  You need to make the decision about whether to stay with him yourself.  I would, however, consider seeking support from a counsellor yourself.  It is great that this website is available for support, but I think that one-on-one help would be far more advantageous for you.
Best wishes, and I really hope things get better for you.
Jacqui