Expert: Erin Madigan Stathis, LMHC, NCC - 12/5/2011

Question
QUESTION: My husband has been an opiate addict for about 10 years now - he is 34. He has been to inpatient rehab twice and also done outpatient therapy. He has been on Suboxone for about 4 years now. Every time he tries to get off of the Suboxone he turns back to hydro/oxycodone and then eventually gets back on Suboxone. He started out at 16 mg a day and is now down to only 1 mg one day and 1/2 mg the next. He is also seeing a therapist for the past 8 months and also within that 8 months has been put on Concerta and Cymbalta for ADHD and depression. No one seems to know a whole lot about Suboxone and how to properly taper off of it and more importantly STAY off of it . . and other opiates. He has tried several different ways to taper . . . always relapsing. He says the withdrawls are alot worse than hydrocodone and last alot longer and that is what makes him go back to using - he cant take it. ANY help would be very much appreciated. Thank you.

ANSWER: Hi Sue,
It sounds like your husband is in the middle of a successful taper now.  I understand your concern since you've seen him go through this before only to relapse later.  The thing is, this is your husband's recovery and treatment, not yours.  This is his journey.  You can help him, but you can't do it for him.  I wonder why it is you (and not him) asking this question.  The reason I wonder is not because it's wrong for you to ask.  It's clear that you love your husband and want what is best for him.  He's lucky to have someone like you looking out for him.  However, unless he's asked you for help with this, he may not want it or value it.  It is up to him in the end anyway, what he and his treatment team plan for his treatment.  You have to make sure you are ok in all of this.  Do you have a counselor?  Opiate addiction can be just as devastating for you as it is for him.  Take care of you, too.  OK?  This is a great website of an organization here in Massachusetts.  I don't know where you are:  if you're here, I'd strongly suggest going to a meeting.  They're free.  If you're in another state, check out the website anyway:

http://www.learn2cope.org/

With that being said, I have some thoughts that might help.   I don't know any specifics about your situation, so I hope the following info is helpful:

Your husband will need to continue treatment after his taper.  You didn't mention any after-care in your question.  I wonder if he has a plan for this.  He'll be most successful if he has a plan to continue treatment after tapering off of Suboxone.  Many times people struggling with addiction will go through a treatment program (either detox, medication like Suboxone or other kinds of treatment), get some sobriety, feel better, then stop treatment.  This is when the relapses happen.  Treatment has to be ongoing.  If your husband had high blood pressure and stopped taking his medication because he was feeling better, his blood pressure would go back up.  Blood pressure medication only works when you take it.  Addiction treatment is a similar principle:  if you stop treatment you're a lot more likely to relapse.  

Does he have a solid connection with a sober community?  He should not taper from Suboxone unless he has cut off contact with people who are still using, has made a solid connection with a community of people who can be supportive of his recovery - a community like Alcoholics Anonymous, Narcotics Anonymous or other recovery programs, and has stability in other areas of his life.  His current counselor should be able to explain to him (and probably already has) when it is a good time to taper.  If he doesn't have a counselor he'd be more successful if he got one - one who is an expert in Suboxone treatment.

I truly wish you the best and hope this little bit of information has helped.  I wish for peace for you and your husband.
Sincerely,
Erin M. Stathis, LMHC, NCC


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

QUESTION: First of all THANK YOU SO MUCH. You are fabulous!!  And thank you for the link you sent. I am taking care of me . . now. It took me a while to realize this really IS his journey and I cant "fix it" but now I truly understand . . . and I am going to Al-Anon and getting help for me. My husband was the one that wanted me to ask these questions of you . .  as he is not very good at relaying information himself. :o)  He also wants to know . . where can he find ANYONE who is a specialist in Suboxone treatment??  Because we cannot find anyone and his counselor cannot find anyone and it seems that all anyone wants to do is either keep him ON it for life or give him another shot (Naloxone) to "make it better". He is tired of the back and forth and tired of "here take this pill to replace that pill". The suboxone doc he has has no clue what she is doing and that is VERY unfortunate. I dont know why these sub docs arent forced to go to classes themselves for this drug to learn what it does and how it affects the brain. And more importantly how hard it is to get off of and how much worse the withdrawl is and how long it lasts. She just told him "I have never had anybody else have a problem getting off of it". It's a shame really. We are outside of Nashville, TN. ANY help would be very much appreciated. Thanks so much so far for all you have sent back to me/us.

Answer
Hi again Sue,
Glad to hear you're involved in Al-anon.  That's great and sooo important.  I'm not sure I can help with the rest of your questions.  I'm not in your area and therefore, definitely not an "expert" about Suboxone treatment in TN.  Suboxone docs DO have to have special training in MA.   I'd be surprised if that was not the case in TN.  Be careful with Suboxone doctors that refuse to accept insurance.  Some are unfortunately corrupt and not looking out for their patients.  This is a very small percentage, but worth being aware of.

See if your community health center has any doctors who prescribe Suboxone.  If they do, ask who they work with to provide counseling.  I work in South Boston, where people on Suboxone are REQUIRED to be in therapy with an addictions specialist who is informed about Suboxone treatment.  Unfortunately, I cannot provide information about TN because I just am not familiar with that area.  Maybe "harm reduction" programs will have information about Suboxone specialists?  Ask around.  It will be important for your husband to have one.  It's not enough to think "oh well, I can't find one."  It's a must, so keep asking around.

Good luck to you both.
Sincerely,
Erin M. Stathis, LMHC, NCC