Archive for the ‘Kids Using Drugs’ Category

The Family of an Addict

“Just found out my son who is on suboxone treatment, is also taking Xanax from a dealer. He came home this a.m. and dropped into a dead sleep. I checked his phone and found a message requesting Zanny from a certain Austin. I do not want to be his cause of death. Do I get tough and kick him out, or continue to try and help him? I am worried that his doctor will not continue to give him the suboxone if he tests positive for Xanax. I am worried if I kick him out, he will go back to heroin use. I feel damned if I do or don’t. I am a believer in prayer and God, but right now I am in a quandary. Any suggestions?”

I saw this comment on my site today and thought it would be an excellent topic for a blog post. My heart goes out to this mother.

It’s not just the addict who suffers from this disease of addiction; families also feel pain. Addicts are fooling themselves when they say they have a right to do what they want with their bodies because they are only harming themselves. The addiction causes the addict and all who love him to hurt.

This mom wants to know what she should do, and I’m tempted to give advice.

On the one hand, anything she does to make it easier for her son to use drugs is making his addiction worse. She should call his doctor and tell the doctor what’s going on, and let the doctor take it from there. If her son decides he wants to keep using Xanax rather than get into recovery, that’s his decision, not hers, and if he’s over eighteen, then his recovery is his responsibility.

And then on the other hand, it’s more difficult to overdose on Suboxone and Xanax than on a full opioid like oxycodone and Xanax. But overdose is still possible. If he stays on Suboxone, at least that’s reducing his risk of death. In the end, his doctor is going to do drug testing and it will become obvious what’s going on.

Not being a parent, I can only try to imagine how difficult her situation is. Most people are overwhelmed and unprepared for such grim circumstances. When she says she’s “damned if I do or don’t,” she’s right. She cannot control the outcome. She cannot cure him.

I know a mom who allows her son to live in the basement, fully knowing he is injecting heroin. She sometimes gives him money to he won’t have to commit crimes to finance his addiction. She says if she turned him out and he died on the street, she would feel awful, like she had abandoned him. On the other hand, I know a mom who did the same thing, and her son overdosed and died while living in her basement. She now feels like she didn’t do enough to help him, and that she contributed to his death by enabling him. At an Al-anon meeting, I heard a mom crying because her son died from a violent assault from a drug-using associate, shortly after she kicked her son out of her house for using pain pills. She felt like he might still be alive had she provided a safe place to stay.

This disease often kills young people, no matter if their families enable or provide tough love. Families can set boundaries, do interventions, and give consequences for continued drug use. They can reduce harm to the addict who is still using, by giving clean needles and a safe place to life. And the result may be the same either way.

I do know this mom needs to get help for herself. She can go to Al-anon, a 12-step recovery program for friends and families of alcoholics and addicts. It’s free, available in nearly every city, and it works. There, she can meet other moms and spouses and adult children of alcoholics who can share what they did to restore sanity to their own lives, independent of what their addict or alcoholic is doing. Or, she can go to a therapist to help her decide what course of action – or inaction – is right for her.

I had an addicted family member. I decided to be direct with him. I told him how I loved him and how I was worried his disease would kill him. I told him that I would pay for a treatment center, if he would go. I would go with him to 12-step meetings if he wished. I would support him in any way he thought necessary. The first time we talked, he made a joke of it, said I was worried for nothing, and he didn’t have a problem. Even though it wasn’t the response I hoped for, I felt better, because I said something I desperately needed to say. I was able to speak my truth to him in a way that felt good. I didn’t blame or shame him. I just told him I loved him and I was worried, and if he wanted help, I’d move mountains to make it happen.

I didn’t cut him out of my life, but decided what my boundaries should be in order to maintain my sanity. I couldn’t be around him if he was obnoxiously drunk.  When I visited him, I always drove my own car in case I needed to leave if I started feeling overwhelmed. And I would not, under any circumstances, buy alcohol for him. I told him I didn’t allow drinking in my house, and if he came for a visit, he couldn’t bring alcohol with him to drink. I believe he did his best to honor my requests, but he couldn’t control his drinking, and I did have to shorten a few of my visits.

I didn’t nag him, but after he was admitted to the hospital with liver failure, I again offered to help in any way I could. This time, he said AA might be a good thing if a person needed it, and if he ever got that bad he’d go to AA. His drinking continued, and he died of liver failure four months later.

I would feel wretched if I had never spoken what was on my heart. It sounds like such a simple and obvious conversation to have, but in alcoholic families, conversations about alcohol consumption are often taboo. Logical and necessary conversations often feel bizarre in addicted families. In my family, we were silently aware that our family didn’t talk about such matters.

It took an unexpected amount of courage for me to be able to talk to my loved one about his drinking.

Besides Al-anon, individual counseling can help a great deal. A therapist, knowledgeable and experienced with dealing with families of addicts is worth her weight in gold. With either option, this mom will learn the threes C’s of Alana: you can’t control his using; you can’t cure him; and you didn’t cause his addiction. For some reason so many parents seem to think their son or daughter’s addiction is their fault, which of course is untrue.

With help, this mom will be able to think more clearly. She’ll be able to decide where to draw the boundaries. I don’t think there’s any right or wrong with boundaries. Each family member gets to decide where their limitations will be with the addicted love one.

For more about Al-anon, you can go to: http://al-anon.alateen.org

Families Anonymous, a similar group, has this website: http://familiesanonymous.org/

Nar-Anon is a 12-step group for the families of addicts: http://www.nar-anon.org

Opioid Addiction in Youth

Parents who look the other way when their kid is using alcohol or marijuana are blindsided when they discover their young adult is addicted to opioids. Parents, unaware of the trends we’ve been seeing for the last decade, are often shocked to discover the prevalence of opioid addiction in youth. For some young people, opioids are the gateway drug, rather than nicotine, alcohol and marijuana as we’ve seen in the past. For some families, the first hint of drug use has been a fatal or near-fatal opioid overdose. For those kids whose first drugs of abuse are alcohol or marijuana, it’s often a short time until they progress to opioids.

Previously, so-called hard drug use was considered a problem of the inner city. But now, most opioid-addicted youngsters live in suburbs or rural areas, and mostly are non-minority.  The purity and availability of heroin has increased, and now that pain pills are slowly become less available, it’s being by some young adults. Many have the mistaken impression they can’t become addicted if they snort rather than inject heroin.

How young am I talking about? Typically, adolescents are described as 14 or 15 to age 18. However, the human brain continues to develop until around age 24, so people of legal age may still think and act like adolescents. The family milieu also influences maturity level. Some 19 year-olds have been functioning as adults for years, while some 24 year-olds may still be financially and emotionally dependent on their parents.

We don’t have much information to guide treatment for opioid- addicted adolescents. Unfortunately there aren’t many good long-term studies to show us which treatments give the best outcomes for this age group. We do know that rather than looking at a treatment episode as a one-time fix for an acute problem, we need to take a longer view. Opioid addiction behaves more like a chronic disease, and one episode of addiction treatment rarely resolves the problem for life.

At the recent ASAM conference I attended in Atlanta, a two-hour session focused on treating opioid addiction in adolescents. Three doctors at that session spoke about their experience treating this age group for opioid addiction: Marc Fisher MD, Ann Bruner MD, and Sharon Levy MD

These doctors are finding that just like in adults, opioid addiction in adolescents behaves like a chronic disease with relapses and remissions. Parents should be advised to adjust their expectations of what treatment can do for their child. Parents shouldn’t expect one treatment episode to “fix” their child so that they will never have to worry again. Adolescents in opioid addiction treatments have high drop- out rates and high relapse rates, probably due to the opioids particular pharmacology. Many of these kids also have co-existing mental health problems which makes treatment more difficult.

Models of inpatient opioid detoxification followed by outpatient treatments alone show high relapse rates. The doctors presenting at this session reported their outcomes using medications in addition to outpatient counseling programs.

They are using both Suboxone and Vivitrol (naltrexone by monthly injection), and allow patient and family preference to decide which, if any, medication to use. Suboxone is prescribed without a clearly defined stop date; rather, the doctor counsels delaying taper until progress can be made in counseling. Vivitrol similarly has no pre-set stop date.

Suboxone, as an opioid agonist, alleviates physical withdrawal and also blocks euphoria from illicit opioids. However, Vivitrol does not alleviate physical withdrawal and in fact will put an opioid addict into withdrawal if started too soon. For that reason, patients are first started on oral naltrexone tablets and assuming they tolerate the medication well, are then given the injection, which lasts for one month. This opioid blocker prevents euphoria if illicit opioids are used, though it does not reduce opioid cravings.

Compliance was better with Vivitrol than Suboxone. This isn’t surprising, since it’s a once-a month medication. And the more weeks the kids were on Vivitrol, the fewer urine drug screens positive for opioids. With Suboxone, not only were there fewer UDS positive for illicit opioids, but also fewer urine drug screens positive for any illicit drug.

These doctors summarized their experiences by saying that treatment with the medications buprenorphine and naltrexone, in the form of Vivitrol, were well-tolerated, acceptable to patients, and easy to implement. Medications can be easily integrated with counseling as a part of a complete approach to treatment. The use of medication for relapse prevention increased treatment retention. And when kids show up for treatment, they have the opportunity to learn recovery skills.

It’s striking to me that an opioid antagonist is producing as good results as Suboxone. Maybe it’s due to the involvement of the parents of these young people. It’s likely many are financially dependent on their parents, and are therefore more accountable to them. Of course the best thing about Vivitrol is that it doesn’t cause physical dependence, and so can be stopped without difficulty when the patient is ready.

It’s not surprising at all to find Suboxone produces as much benefit in adolescents as it does in adults. The main downside of Suboxone is that it’s difficult to taper, and most patients intend to stop it at some point in their recovery.

During the session, and audience member asked the obvious question: how do we know for sure these medications aren’t going to be harmful in the long run, when used in this young age group? The answer: we don’t know. But we do know what happens to opioid addicts who aren’t treated at all, and to those who drop out of treatment. It isn’t good. With opioid addiction, about half of IV users are dead at 30 years, and the yearly death rate may be as high as 15%. When facing a disease with that mortality, what alternatives do we have? Most doctors think it’s worth taking the risk of possible harm in the future to prevent very bad outcomes now. As we gather more data, hopefully we’ll know more about both the long-term consequences and long-term benefits of medication use.