Expert: Caroline West - 2/1/2011

Question
QUESTION: I have a lot of issues with an addicted family member and so I will try to narrow this down to the present question.  I am trying to help a family member who has been addicted to something most of his life.  The past several years he has been addicted to opiates. He has lost everything and is homeless.  I paid to send him to detox, then Intensive Outpatient while living in a half way house. He has been successful for five weeks!  Unfortunately, he is planning to leave town in 2 weeks for a job he is interested in.  He is telling me that he should live alone for his last 10 days in town so that he can get used to living alone.  Putting him in his own hotel room for 10 days is a lot more expensive than the half way program and, even though I don't want to make this about $, I think it is inconsiderate of him to want his own place at my expense.  I am always suspicious that he is trying to manipulate me since that has always been our relationship.  I plan to talk to his IOP counselor this week, but wonder what you think.  I don't think he should be leaving town at all and don't think he needs to live alone in order to transition.  Am I the selfish one?

ANSWER: Hello Michelle.

Firstly-you are definitely not selfish. You have a niggling feeling inside that his reasons for the request of a Hotel room may not be totally honest. He is an addict,has been for many years,and you know the manipulating behaviour of him so you are right to feel the way that you do-not wholeheartedly trusting. Also I have to tend to agree with you that it is a little bit of a cheek to ask you to spend even more money than you already have done. But that is the nature of those with addiction problems,they become selfish and tend not to think about others around them putting themselves first. So Michelle,you are not being selfish at all.

You are being wise too; he has only been clean 5 weeks and already he thinks he can take on a job,out of town as well-it is a bit ambitious,and again,classic behaviour of an addict-impulsive,impatient and unrealistic. As the saying goes,he is 'trying to run before he can walk' and could well end up falling flat on his face. 5 weeks clean time is not much at all,yes it is an achievement,but when he gets out into the big wide world the old issues that made him use in the first place are going to resurface and could lead to relapsing. It is after a user gets clean that they need the most support as it is at that time when the battle against triggers to use begin and these triggers need to be seen through,with support,but still is no easy task.

The best thing that could be done for him is to have adequate,consistent support set up for when he leaves the halfway house. Sure he can get a job,but it should be in a bit more time than so soon. But,on the other side,it could do him good in taking his mind off drugs. Every addict is different and 'one mould does not fit all',but there are some steps that most take which is giving themselves a bit more time to adjust to clean living before trying to resume a normal life. I think he is rushing things a bit too fast. Try talking to him about that. I do understand why he wants to spend his last 10 days living by himself which is as he says to get used to it,but all this,as I talked about,is so premature. Try and get him to slow down.

I don't know what the Drug Services are like where you are,but if they are good,he should definitely have at least once weekly Keyworker sessions to talk about how things are going-that support is paramount without a doubt. And the Care Team may have some alternatives to working straight away in the way of Therapeutic Groups which is the best thing to go for straight after a Detox. Again I don't know what he has available but it is well worth finding out. Also see if there are any Charity run organizations for those with Drug problems. I am suggesting this because I think he is going too fast and he needs to slow down a bit and have that clean time and support before he rushes out thinking all is well now he has detoxed where it just plain doesn't work like that.

Have a chat to him about this and try and get him to look at things a bit more realistically and try to get all of the above in place for him. This is the best advice I can give you.

I wish you and he all the best. But if you,or even he,wishes to talk about this any further than please feel free to contact me again. Take care,Caroline.

---------- FOLLOW-UP ----------

QUESTION: First of all, thank you very much for your time and wisdom.  I don't have anyone to ask.  

I have told him that he will have to stay in his supportive living apt. until he leaves.  He is very unhappy with me for this.  He yelled, cussed and told me he was going crazy there. I can't tell if he is pouting or depressed. His IOP counselor thinks he should stay too. I don't think he has any kind of plan for support when he leaves town.  He talks like he is planning it, but hasn't come up with anything yet.  I don't think he will have any of the resources you mentioned above.

He has been receiving suboxen (sp?) through his rehab and I worry about this too.  While I accept it as part of his treatment, I don't know how I will afford it when he leaves town and he will definitely tell me that he can't make it without the Suboxen.


He has alienated everyone in our family and has no friends at all; I am his last resource.  I know that this is ultimately up to him but when do you stop "helping" someone? I do not enable him with drugs at all but I question whether he will ever be self-sufficient.  I just don't know where to draw the line because he is so incredibly lost.

ANSWER: Hello Michelle.

I truly understand how difficult this is for you. I want to tell you a short story about my ex which may help you.

E (that's how I will refer to him) was so entrenched in the world of drugs that he stole,lied and cheated everybody in his family,his 'friends' and myself. We all stood by him,supported him,helped him in every single way,but he still continued to use us and abuse the help we were offering. One by one everyone got fed up with him,I left him and the last of the remaining family left him as well. He ended up one day just packing his bags,leaving town and heading for the city. We all worried about him but still stood back-we had to. We hadn't heard anything from him for a long time but now,a few of us have,and he is doing the best he has done for over a decade. He still uses drugs but he has a home,a small job,is on the internet,going to the Gym,socializing and getting support from a treatment agency and is in touch with some family members. In other words-us cutting the cords made him stand on his own two feet and it was the best thing that could have happened to him. Yes he still uses,that's his choice,but he is ok.

We had to make that choice because he became unbearable but it turned out well for us-him not being around anymore to hurt us-and for him,starting a new life. I hope you understand what I am trying to say to you by telling you about him. Addicts are very resourceful and do 'land on their feet',and it usually takes something drastic for that to happen. They have to hit their own 'rock bottom',like E,before they get better. Now he still uses and not even what happened to him made him stop. So I'm also saying that with all the help going,it still may never be enough to get a user to quit-they have to do that by themselves,it's their choice. Some quit,some don't. But there comes a time where those closest to them have to make the decision when 'enough is enough' like we all did. Your relation seems to have made no good choices or provisions for himself despite the amount of support both emotionally and financially you have given him. So how much more are you prepared to stand for? you have to decide. You are putting in so much effort and he none,that is not fair on you and doesn't seem to be helping him. He is causing you a lot of hurt and upset and by his attitude,I don't think he realizes how fortunate he is.

If you choose to cut the cord with him,it may well give him the sharp shock that he needs. There is a term called 'Enabling' which refers to someone that is always picking up after an addict,thinking they are helping,but in reality they are not. This is what maybe you are doing which by no means is saying you are wrong,it just means that maybe that is not what he actually really needs to get sorted. He knows you will always be there to help him out so he doesn't try to help himself. Like you asked "when do you stop helping?",I would say now. Then he knows that if he leaves town,which we talked about being a rushed and unwise decision,he won't have access to Suboxone. So if he knows this then he has no option other than to stay put so he can still get the prescription.

I hope some of this has helped you a bit more. I know it's hard but sometimes being 'cruel to be kind' is the only way. I'll let you think on this and if you wish to discuss it some more then you can always contact me again. Take care,Caroline.

---------- FOLLOW-UP ----------

QUESTION: I can't thank you enough for your insight into enabling.  I have tried to be very aware of my boundaries while trying to help. I have realized that sometimes family members are too close to the situation to help.  I told him from the beginning that the only financial support I would provide would have to be connected to rehab. I guess I thought I was showing my commitment to rehab and getting well. I think I am at a stopping point.

Since my last posting, he was kicked out of his supportive living program halfway house about 4 days ago because he was snorting his suboxen.  He was supposed to turn his prescription in to the nurse at the SLP but he kept it instead and took it when he wanted.  He later confessed to have been snorting it for the last month and a half.  I was under the impression that crushing it was supposed to make the person sick???  

He has $350 and a car.  He still wants to leave town for a job.  I have told him that I will not fund any part of that endeavor because I do not believe it is a healthy choice.  He also has the option of staying in town and trying another halfway house program, but he will need to pay for it.  He doesn't want to use his money for that because he says he will need the money for when he gets out.  One of the huge sticking points is that he says he can't get a job because he has drug related charges pending against him in another state.  He won't even apply for a job locally because he says they will do a background check, see the charges and have him arrested (that has happened to him before).  No one agrees with him and we have told him so.  The only reason he has survived this far is because others have paid for him to go to rehab and supportive living.  I really didn't mind funding that because it was all about getting well not enabling.  At this point I feel he abused the situation; he knew the rules of the house and didn't follow them, therefore he has forfeited my financial support.  Anyway, here is my question...Do you think I am being inconsistent by not funding a future half way house since it too is related to sobriety?  Also, he is completely addicted to suboxen.  I am not sure if it is healthy for him to continue it or to cut it off too.  I feel betrayed that he has misused his suboxen but don't know if he has a chance to stay off opiates without it.  He has also been prescribed an anti depressant and it worries me to stop funding that.  He is in deep, deep dependency.

This whole ordeal has fallen smack in the middle of a huge ice/snow storm and we have allowed him to spend the night at our house and sleep on the couch but have made it clear he cannot live here. I am anticipating one to two more days of snow emergency weather and then he should have made a decision.

Answer
Hello Michelle,hope you are well.

This really doesn't surprise me. I knew he was no way near to what is termed 'ready' to quit using and to start working on his sobriety-the signs were all there,and you have been let down again. Snorting Suboxone just clearly shows his unwillingness towards his becoming clean. I'm afraid to say that he is a long way off from actively doing the right thing by his addiction problems.

Just to clarify. Suboxone can be crushed and snorted and still work in that it gets to the brain quicker for that 'rush' than the correct way of taking it dissolving under the tongue. It is when it is crushed and injected that it has no effect and can put the user into instant withdrawal. And on this note,he is still,after ALL the help he has been given,still trying to get a fix and get high by abusing his prescription like that. He is no way ready to get clean. Now knowing this,what do you want to do by him?

Anti-Depressants can help a person. When an addict is depressed the first thing they seek to numb the pain and misery depression brings is a drug of some kind just to tolerate the pain. So,the meds he has been prescribed,providing he takes them properly which is at the same time every single day with no breaks,may lift his mood and help considerably with his drug use. But,Anti-Depressants MUST be taken properly and unfortunately can take up to 6 weeks to have it's full effect. The other problem is that there is always the lowest starting dose given first then monitored as to whether the dosage needs increasing and also the particular brand tried first may have no effect and a new one needs to be started. So even with them,there has to be much patience and we have already seen that your relation has little of that. And as addicts tend to lie,how will anyone know if he is taking the medication properly and having follow up checks?

I fully understand what he is saying regarding employment. Not many managers are willing to take on someone who has past drug abuse issues and/or have a criminal record. I know first hand of this and regardless of what anyone says,it really is a problem and is really difficult to get work. So I totally sympathize with him on this. However,there are Charities out there that help ex addicts and those with a record get work. I know this for a fact but there needs to be a great deal of searching,especially in the US to locate such organizations,but they do exist and they work with employers to help people like him. Again it would probably be you having to do the searching. But maybe that could be a better way other than financial help that you can give him.

So sadly he is still trying to get high by not taking his medication properly and the reality is that if he loses his Suboxone script he will no doubt be back on Heroin/Opiates. So what do you do? Fund the prescription and keep him somewhat safe but having the knowledge of what he is doing with his script,or cut the funding for it and he goes back to the danger of what street drugs possess,it is a very hard call for you to make. He has to address the root cause of his drug use,where there always is one,first otherwise he will continue to use. This last program did not provide the adequate help he needed so I would say to forget about another half way house and get him into a long stay Rehabilitation home. Over here in the UK the usual length of treatment in an 'in-stay' Rehab is about 6 months but most of these are funded by the state,and even that length of time sometimes doesn't work for everyone,but it helps. With each attempt at getting clean is one step closer to cutting the addiction for good. Has he tried doing the 12 Step meetings with Narcotics Anonymous? (that's the one to go to for drug issues,not drink which is AA). They are all over the world and no doubt there will be many meetings nearby he could attend.

This is so hard for you and you are faced with a real dilemma,but I would say,if you have the funds then pay for him to go into a Rehab and forget the half way house and while you are waiting keep him on the Suboxone script for his own safety. One day he will make it but that lies with him.

With drug abuse it is very difficult to treat and causes a whole heap of additional problems but there is always a way out but can take a while to find it.

I hope some of this has helped. I wish I could give you a sure fire solution. But know that you can always contact me again if you need to talk some more. I've been off sick for a few weeks until today so I hope you didn't write in to me before I left for sick leave,if so I sincerely apologize if you have had to wait this long. I made sure I answered all my pending questions before I took leave so I hope the All Experts system didn't overlook your question and you did in fact write in today. Take good care and write back if you need to,Caroline.