Expert: Peter L. - 3/17/2011

Question
I've been married to my husband for 5 years. He took on so much when we got married that I never thought any man would. I was diagnosed with MS (multiple sclerosis), anxiety, major depression a month before we got married and recently PTSD. Then there is our two boys (biologically they are not his). Our oldest ,13, was diagnosed with ADHD, ODD, and depression. Our youngest,6, (who has know no other dad) was diagnosed with ADHD, and ODD as well. So in my eyes for him to take on all of our issues not to mention an all ready made family is incredible.
I have always know right from the start that he was an recovering addict. He was addicted to opiates. He has been dealing with chronic pain and went the pain management route that unfortunately didn't help. He doesn't like to tell his pc that he has a problem in fear that he'll be treated differently. So all the times she has offered him narcotics he always said no. He was on the clinic for some years but got tired of that but continued any way (he was in the process of coming off). Back in Feb of this year he got an injury to his eye and almost lost his sight. We don't live near any hospitals that are able to handle those situations so we had to travel well over an hour to get help. Unfortunately we had to stay there due to major snow storms we were having so he missed his doses of methadone. He didn't tell the dr's he was on the clinic so when they offered him oxycodone for his pain he finally gave in and said yes. By him saying yes of course put him on a down ward spiral. At some point he meet up with the same people he use to get his heroin from. That is his drug of choice. He finally came clean with me so off to detox he went. I can't remember how many times he has gone it's been so many. When he first came home he had a very good out look on things it didn't' take long for the stress of financial issues and many more to take their toll on him. He went right back to the heroin.
I found an empty baggie while doing laundry. When he got back from work I confronted him. At first he was trying to say it was old but quickly told me he started again. I honestly don't think he was ready to stop and still isn't. He finally got back on the clinic March 15. He just came to me asking if I think it's a good idea if he starts coming off soon. I told him no. He doesn't want to continue with the clinic. He has tried suboxen in the past and that didn't help either. So what else is there? He told me this time it was the worst his addiction has ever been. Unfortunately I can't lock him in the house and throw away the key as tempting as that sounds. I am terrified that if he comes off the clinic he will just go right back to using. I am trying to be as supportive as I can be. I told him I will go to meetings with him, marriage counseling, anything to help him beat this and get our marriage back to where it once was. I can't lose another person I love too drugs it's too hard. My father will be gone 7 years March 19. Ironically the same day my younger son was born. The first time he used again after 5 years was his last.
I am open to any and all suggestions that you have. I will try to answer any questions that you may have if any. I know that this may sound all over the place or have things that i may have forgotten to put in. Thank you so much for taking the time to read and respond. You are doing a great service to this society and for that I thank you.

Theresa

Answer
Hi Theresa,

My apologies for my slow response.  We are seeing a lot of opiate dependence (heroin, pills) in our program these days.  I've worked with those with all kinds of chemical addictions: alcohol, pot, cocaine, methamphetamine, and of course opiates.  What's interesting about treating opiate addiction is that almost always the treatment involves an opiate replacement therapy, such as Suboxone or Methadone.  I get a sense that everyone - clients and clinicians all - feel there is limited success in using only "talk therapy" to manage this addictive behavior.

As a result, almost everyone I work with who has an opiate addiction is also on Suboxone or Methadone.  They often are in counseling programs too - and our program requires that - but I have to say this seems of secondary importance to my opiate clients.  In other words, they would not do the counseling if they didn't have to, just get the Suboxone or Methadone.  I firmly believe that.

The conclusion?   There's a strong physical component, maybe a long term withdrawal syndrome, that must be addressed.  The opiate replacement drugs accomplish that.  Still, sadly, many of our clients mess around with marijuana, cocaine, or alcohol.  So, they are dealing with their most pressing addiction (opiates) but still find reason to use other addictive substances.

Getting to your husband, he has to decide what to do to remain substance-free.  He has to sort this out.  Why does he not feel Methadone is useful to him now?  Where is he having the difficulty remaining abstinent?  Is it that he is around other users thus making him vulnerable?  What is he doing to resolve the financial issues?  What are his feelings about your marriage, homelife, children?  What does he aspire to?  Does he have a career?  

I'll present no illusions here -- opiate addiction is very difficult to overcome.  There is evidence the brain undergoes some structural changes or adaptations that make this recovery difficult.  But they are not irreversible.

My suggestion?  That he stay on Methadone or Suboxone long term.  He has to do something to help himself and something has to work.  If he rejects opiate replacement and comes off it too soon, he is saying he wants to manage this addiction himself via his own resources (a long shot) or through intensive work with a counselor (maybe).  Or, if he wants to continue getting high, he should buck up, leave the house, and not bring the family down with him.  

There's no free ride here, and no "I don't know what to do!"  The ball is in his court.  You're being supportive, and that's great.  He's lucky to have you.  Just keep his feet to the fire or his continued use will be very detrimental to you and the children.

My best to you,
Peter