My Friend Needs Help!

From a concerned friend of an addict:
Hello,

My name is Kayla. For the past year my best friend has been struggling with his addiction to oxy. I have been trying my hardest to help him through it and be there for all the hard moments. Recently he has used heroin, as well. From what he says, he has only used heroin a few times. Whether or not this is true, I guess it doesn’t matter. He goes to school in Milwaukee, but I think he’s going to come home soon – he says he wants to come back and get some real help. He’s been in and out of treatment already in the past year but ends up getting sucked into his bad habits. He’s been perscribed to suboxone and has been taking it for months, I’m afraid it’s not going to keep working for very long for him.

Today I heard about you from somebody I work with and was curious, so I checked out the site and I am interested. How would you go about treating him? And do you have any suggestions as to what “groups” (AODA, etc.) around the Oshkosh area that would be helpful for him?

My Advice:

Hi and thank you for writing. I’m sorry to hear about your friend. It is very difficult to watch a loved one destroy himself, particularly from drug addiction because one has the impression that there should be something that will fix things and make the person stop– if only we try harder. The usual result is that the person addicted keeps on using, and everyone around the addict is working like crazy.

The bad news is that nothing changes until the person in the middle is doing all of the work– and that doesn’t happen until the person has no other options. And THAT usually requires that all of the nice people who are doing their best to help stop helping. The addicted person will then eventually get to a point of desperation, brought on by poverty, legal problems, incarceration, loneliness, health problems… and finally, hopefully, take a look at the situation and decide to change.

I realize that I’m not making you feel any better here, but this is pretty much how it always works. There is a wild card, and that is Suboxone– with Suboxone a person can get help at a much earlier point in the progression of illness. This is both good and bad; the good news is the obvious– the possibility of escaping addiction before everything is destroyed. The bad news is that people who escape earlier are more likely to forget the horrors of addiction and return to using. It sounds like that is your concern for your friend.

Suboxone is an interesting medication and it presents some interesting dilemmas. I talk to my friends at the AODA treatment center where I am med director; the counselors there are all firmly abstinence-based in their thinking and so they don’t like Suboxone. I see their point, and hope that they see mine. In the past, recovery from opiate addiction was for the few people who survived long enough to hit rock bottom, and then only after severe consequences. Even after the consequences the success rate of traditional treatment is discouraging for opiates– and in those who do get clean, opiate addiction tends to recur– sometimes after many years. Addicts need to continue meetings to stay clean– for the rest of their lives. Compared to these characteristics, Suboxone is a good deal in my opinion– people can get clean with much less desperation and much less motivation, making recovery from active addiction available to many more people. BUT– those people must usually continue on Suboxone– for the rest of their lives!

The abstinence-based counselor says ‘but they are now stuck on Suboxone!’ I say, ‘at least that is better than where they used to be!’ It is sort of a ‘glass-half-full’ vs ‘glass-half-empty’ situation.

The big question: Once a person is stabilized on Suboxone, now what? We have nothing at this point that has been shown to be particularly helpful in maintaining sobriety from that point forward if Suboxone is stopped. Some docs send patients to AODA groups or 12-step meetings… in my opinion those things are great if a person is strongly motivated to do them. But speaking as a recovering addict I know that the 12-step program only works if a person is desperate– and people on Suboxone are not desperate! It is a ‘catch-22’ (all you young folks out there need to rent that movie): The better a person does on Suboxone, the happier and less desperate they feel… making 12-step groups less likely to be effective.

My suggestion after all this is that you work toward helping your friend remember just how miserable things were before he got on Suboxone. In my experience, younger people tend to forget the misery much faster than older folks. They start fantasizing about the ‘good old days’ of using, that weren’t all that good in reality, but that start to look better when seen through a bit of time and a bit of denial. If you have them, show your friend old photos if how he looked when he was scraggly and miserable. Tell him about what you thought of him when he was using, when he was only concerned with himself and getting high. Tell him how much happier he seems when he isn’t using, and if he argues with you tell him he is full of sh&&t and that he should do some serious recollecting.

The other thing is to help him get his mind around ‘powerlessness’, which is the mental attitude required to stay clean. Will power is the enemy. The reason is because if I have will power, I have no reason to stop using today— I will stop tomorrow. This is another irony of addiction– the ability to stop using depends on powerlessness and humility, not on strength and will power. Remind your friend of how many times he promised he was done, and how many times he proved that he had no ability to stop.

If he is into AA or NA, there are plenty of meetings in and around Oshkosh. But if he tells people at a meeting that he takes Suboxone they will all jump all over him, because they don’t believe in that type of approach– they think everyone should do it the way that they did it– the old fashioned way. This is the other conflict with Suboxone and traditional recovery; recovery is based on the premise of ‘rigorous honesty’, and the first thing people on Suboxone have to do at a meeting is to lie!

For religious people, the best answer is to pray for him. I’m not particularly religious myself, but I think that is likely the most beneficial solution for anyone who cares about a person who is an active addict. It is nice that you care for your friend; please do NOT make the mistake of thinking that you can change him, and for goodness sake don’t ever marry a person who is actively using– you will only end up as miserable as he is. If people could make decisions based totally on logic, the best course of action would be to run away, send him your phone number, and tell him to call you after he is clean for a year.

Take care,

SD

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