Addiction to Drugs/treatment of ADHD for recovering addict
I have a 19 yr old son who had two bouts of heavy (daily) heroin use for approx. 3 wks. His last bout ended when he overdosed and went into toxic shock. He came very, very close to dying. He was in ICU and the doctors didn't think that he would pull through. The cardiologist told him he sufferred heart damage. He was discharged and sent directly to a very good inpatient rehab. He has always dealt with severe anxiety related to new places and this made rehab hard to tolerate. He kept walking off, sometimes in the middle of the night. He could not be given anti-anxiety meds because his blood pressure was still too low. After walking for miles, he would call us when he found a phone. We continued to drop him off again. After a week of this we brought him home and he went through an outpatient program which he completed.
This was 6 months ago. He never fully engaged in the 12 steps and has said that he will do this on his own. We test him frequently (2-3 times a week) and randomly, and he was clean for the first month. After that he started smoking pot again. He also drinks. He has not done opiates or anything other than pot for 6 months. We will not allow him to drive until he tests clean for THC.
He is now going to college and living at home. In high school he was diagnosed with ADD - not impulsivity so much, but spacey and hard to complete tasks and pay attention. We decided not to medicate him, hoping that he would develop coping techniques and learn to compensate. We did, however, give him klonipin when he was suffering anxiety, but it's hard to evaluate its effectiveness because by then he had already started using.
Here's my main question: We regret not treating his ADHD when he was first diagnosed, because it may have helped him stay away from drugs. This first semester in college was horrible - failed two classes, registered and completed a class he didn't remember he had already taken. He never figured this out - essentially the same material only a different teacher. He got a D. During the semester he never tested positive for anything other than THC.
At this point, understandably, he is discouraged. Normally, I think he would benefit greatly from Adderol. Do you think it's too risky to give him adderol? And, obviously the pot is bad. It seems extreme to say 'rehab or the street' due to pot, especially in light of our fear of the H word.
Is it possible to be an addict for a hard drug, give that up, but then smoke pot and drink and never become addicted to those things?
Thanks for describing your situation thoroughly; that allows me to give a clearer response.
Consider him to have made major progress stemming his opioid addiction. Opioids are insidious and very difficult to break away from.
There are a number of considerations here: 1) Many opioid addicts regard marijuana as relatively harmful, compared to what they were doing. Many use marijuana, alcohol, or benzodiazepines to resolve the mood disturbances (and potentially ADHD) often a long-term consequence of opioid use. I find my opioid patients suffering from mood dysregulation almost invariably when in recovery from opioids. This can last quite a while, maybe a year, or longer.
2) Marijuana seems a drug of choice for those with ADHD. Its addiction potential is moderate, compared to other substances, and usually we regard cannabis dependence as psychological, rather than physical, as is the case with opioids and alcohol. Hence in people's minds it appears to be "cleaned up" and made relatively benign. There are lots of people on opioid maintenance therapies who smoke pot. Lots of prescribers of methodone and Suboxone give up and let their patients smoke; it's all about harm reduction in their minds.
Your son could certainly continue to use these substances in a way that does not resemble addiction necessarily, but that doesn't mean they are harmless. Many people will say how much they tried substitution and ended up going back to their original drug. The reasons for this are not yet clear, though.
We do not practice harm reduction vis a vis marijuana smoking in our program, even though our clients would ultimately like us to "get with the program" and by ignoring it essentially rubber stamp it as OK. It's even worse in Massachusetts, or states where it is legalized or decriminalized.
I do not think it's too late for your son to take Adderol, or another ADHD medication. Do it as a trial -- see how it works and how well he tolerates it.
Good luck with this,