Expert: Peter L. - 5/17/2011

Question
My son is now 28 years old. He finally graduated college in March of 2010 and has moved back home. He has 2 student loans totaling somewhere around $ 120,000.  I have always suspected him of Drug & Alcohol abuse, but since he has been home have seen a completely different Son then the one that went away to school. Around 5 months ago, ha admitted to me that he was using Prescription meds, when I told him I wanted him to go for rehab, we made an agreement to see our Doctor and do what he recommended. The final idea was to send him for testing once a week. Except for some Weed, he was clean.  However, that has stopped now for a couple of Months.  The other night I was going to Charlie browns with 4 other guys (my age) and invited him to come along. I noticed he was not the same, and quite a few times he was falling asleep while eating with a fork in his hand. (what drug causes this?) Tonight I am going to go to a Al-Alon meeting a few towns over and listen and maybe ask questions.  My Wife is also very concerned and I am going to see if she wants to come along.  He has agreed & is going to see a psychiatrist tonight a 5:30, but I am worried he will use this for medications.
He has gone to multiple Doctors and gotten medications, lost most of his friends over the past 6 months, stays home most of the time while sleeping during the day & awake at night. No motivation to work (or anything for that matter).
I just don't know what to do for him and my Wife & I.
If you have any recommendations, I would greatly appreciate it!!!

Thank you,

Tom

Answer
Hi Tom,

My sense is that your son has been using opioid medications, though you did not specify which prescription med are the issue here.  What you are describing, e.g., a completely different son, falling asleep while eating with a fork in his hand, and your suspicion that he might be medication seeking.

You may be aware that opioid drug use (prescription drugs like oxycontin, percoset, vicodin, oxycodone, and of course the street drug heroin) has reached very serious levels in the US.  These drugs are being abused everywhere.  Individuals who are being prescribed them legitimately for pain management are becoming dependent on them, and they have entered the drug use mainstream, after opioids being more so a drug of the inner city for many decades.  As a substance abuse counselor for nearly three decades, the surge in opioid dependence has me more concerned than any other trend by far.

What makes these substances so problematic is their very rapid and aggressive addictive potential.  There is also evidence they incur rapid changes in the brain reward system, dramatically affecting judgement in terms of how one pursues this addiction.  We treat many opioid addicts in my program, and they are some of the most, if not the most, treatment resistant individuals of all.  They are the most deceptive, manipulative, and avoidant of substance abusers.  We deal with severe behavioral and personality disorders associated with this population nearly every day.

Opioids are the only class of drugs for which the treatment is almost always another drug, in this case what are known as opioid replacement or opioid agonist medications.  They are known as Methadone and Suboxone.  The latter is newer, more highly recommended, and considered by many an evolution over Methadone.

Now without knowing what your son is using exactly, it is not clear how to proceed.  That information must be obtained.  You have managed to get him to agree to urine testing, and that's a good first step.  But if he's stopped the testing you have no idea what he may be doing now.  Ultimately, he needs to get a substance abuse evaluation.  The psychiatrist is useful in an overall program of addiction treatment, but not as an end in itself.  Addiction treatment addresses lifestyle issues that are associated with substance use, while teaching cravings and relapse prevention techniques.

If your physician can agree he needs the evaluation, and can help get him there, all the better.  But I stress the addiction program response to his situation, rather than merely physician-based/medication responses.  It is likely the substance abuse program will recommend Suboxone, if he proves he cannot manage the very difficult opioid cravings via cognitive-behavioral approaches alone.  Suboxone or Methadone are almost always, at some point, recommended due to the intractability of opioid dependence.  

I'm originally from New Jersey, and know there are a lot of good programs there.  You might want to check out the federal treatment directory.  http://dasis3.samhsa.gov/

Let me know if I can help out further.

Regards,
Peter