me again!

[maggiem]

Hi all....me again!
Advice please.   Daughter home again after failed relationship, she is ok but at low ebb about life atm. This all happened when we were away on holiday...'Mum I have come home but I am ok cos I will be in rehab soon, so want to sort my life out'.......great just when I thought all was going smoothly.
Apparently she was on the list for rehab but somehow this is now not happening because again she has a new key worker so no evidence of rehab request. I asked about her care plan and she says she hasn't seen one, she feels trapped in a corner with no way out. We want to help with her blessing but not sure what to do.   She is down to 15ml and has been on daily supervision for the past 12-18 months.  She is desperate to reduce herself seeing that rehab is out of the question now.
Believe me I know my daughter after the past few years of this dreadful journey and she is finally desperate to get off the last few mls and try to get her life back on track, what can she do?
Can she ask for un supervised?
Can she ask again for rehab? (been clean for 18 months at least)
She looks the best we have seen for a long time, but I fear for her mental state,  in her own words, what have I got Mum? I'm 28, no job, no man, no money, no prospects, and no hope of getting help!!
What worries me is her inability to face problems head on, she has lost her self esteem, confidence. What is she going to feel when she reduces if she feels like she does now?
Sorry ....too many questions.
Ideas please
Maggie

[usandthem]

Hello Maggie,
I am John and I am a service user who has been in and out of service for the last 17 years now.

I too have been illicit free for many years now and in service maintenance. I decided (MYSELF) to taper down my script. I am now on 30mls and am leveling out for a few months (staying at the same level of 30ml for a while beforehand) and then step down another 5mls in 1ml monthly reductions. (Very slow). But that's me and we  all approach treatment and respond to it differently. First thing is first it has to be 100% what she wants to do and not peer pressure or pressure from any family member for her to try and live up to 'social norms'. Methadone treatment is married to heroin use and so can bring an unwanted outside social stigma to it.

 I assure everyone that in recovery, stability is the key. The next thing is support, but the ultimate key is the treatment is owned fully by the service user. If your daughter seems to be at a low ebb and is not sure what to do - then she needs you to tell her that you will support her in whatever she decides to do. Now you probably already do this but keep re-assuring her.  Also let her know that there is no rush to race off her medication and you will support her in a slow reduction if reduction and abstinence is her primary aim. If she feels worse for tapering down then she should stay maintained at the level she is at. Some users can not go through with reduction and opt to stay maintained. This is not a failure, on the contrary it is a success to be maintained as you are still heroin free and stable and that is a result in itself. Her depression and anxiety and confusion and lack of motivation could be from reducing down or racing off her therapeutic dose too fast. This can have side affects called 'PAWS' post addiction withdrawal symptoms.This is the body's metabolism craving the last dose; which has been removed. This on top of a bust up will be a too much for some people to bare.

Reducing down from higher doses is a lot easier, but as she tapers down - her drop % rises, and it becomes harder. Maybe if she leveled off for a while and stay static for a month or two, and then take it from there. SLOWLY

There is a huge gulf between recovered as an ex-addict doing really well and a frequent heroin user. So well done for your daughter for having the courage to think ahead. Methadone is the key to being heroin free if your desire is to be heroin free. You do, however,need to be really committed and have your support and have plenty of other hobbies to fill your day if you choose abstinence and post treatment. This is a slow process and it will come. Finding new friends is a great move forward but its not always that easy to do. Coming from a drug fueled hectic day of scoring and earning to being leveled off and maintained and looking for a new direction is part and parcel of opiate treatment, and its a long old road. 'Rome wasn't built in a day.' I am sure there are plenty of initiatives for her if she want to look for things to do post treatment. Her local service provider has all sorts of re-integration steps and courses. So do wish her well and good luck. Remember, its not a race.

P.S. After 18 months of cleans she should be able to get take homes - but you have to ask them they rarely offer it or just forget to. Supervised should only be for 6 to 12 months or so depending on the service user and key-worker.

John  

[angiesims AKA true grit :)]

yes agree with everything useandthem says. your daughter sounds very much like I was. she should really be getting weekly pick ups. it would be harder finding a job with daily supervision. and that alone would help her only having to go to the chemist once a week. maybe if you go to see her key worker with her if she agree's. she's done great and should be proud of herself as its not easy. she sounds stronger than she thinks

[sapphire]

Maggie - the problem (as you I'm sure know), is always funding, and if they (the DSP) see that your daughter has got down to 15ml off her own bat, then they will be wary to prescribe rehab as they will feel she is doing well enough anyway.
I know that's a shite state of affairs, but that's how it is.

I would get her to speak to the manager of her DSP, if her keyworker is not up for puttting her forward for rehab. Her DSP should know that getting down from that last little bit is where people often need the most help.

If she has been giving screens/swabs free from illegal or unprescribed drugs and is not drinking, there is no reason she should be on supervised consumption still.

Reallty though, she's done a bloody good job getting down to 15ml on her own, and should be really pleased with herself.

Any drop in dosage at such a small dose of 15ml/day is going to be massive, so it may well be a longer process than you or her had initially thought, but better to do it slowly and properly than rush and be back to square one, especially after she's done so well?

John mentioned in his post PAWS, which there is loads of info on out there, but have you thought that it may be better to stay maintained for a short while, if she is having problems in other areas of her life? Stability really is key.
As John says, it really isn't a race!
 
I would definately ask about getting off supervised consumption though, as even if she did get a job, it would be a nightmare having to get to the chemist every day.

I hope you are looking after yourself Maggie, as it can be a nightmare caring for people with addictions!

[OP8S]

Can't add much to that. Slower the better & even if your daughter gets stuck it's no big deal, certainly if she starts getting take-away. It wont get in the way of a job, I've always managed , sometimes by the tips of my fingers looking back to hold onto a job. Thousands of people on meth work, little green worker ants!

[try to be balanced]

I would say that in 15 years apx of working in the field, I would have had at least 500 different patients; I know less than a handful of patients who have reduced, detoxed, stayed out of addiction/ treatment long term WITHOUT being employed.   I would say there has been ten / twenty times that number who WERE in employment.

I would suggest asking the CDT manager the above; and additionally be using as much purple documentation at them as possible to back up your reasoning.

Additionally, it may be worth looking into Lofex overlap if the final reductions are too tough.

[maggiem]

Hi all
Thanks for the replies.  We are coping suprisingly well, we are there for her but find our lost space a bit of a pain!!! Our levels of patience have dropped but she is aware that we will support her if she is honest with us.  Actually there is a dramatic level in committment and trying to be open and up front.  All her decisions are hers, we can only offer suggestions and relay comments from this site. 
For some reason she does not want to read for herself the guidance and first hand postings, or perhaps she does!
As for her un-supervised pick up, she had cocked things up in the past and they are being cautious, also she is drinking too much so I suppose this goes against her. We offer to take her to the doctors, dentist etc but it seems as if she is scared of what is or could be wrong with her. We never press her into things but get very frustrated with her inability to face things head on and get things sorted!!! Suppose its still too early.  She was diagnosed with hep C, started treatment but never went for follow up diagnosis,  think she is scared.
Cannot believe how far we have come since we moved away from the source of her problems, she has gained 3 stone, looks brilliant, is a lovable daughter(again) but the biggest problem is the inability to move on to employment and independance.
We know it will come eventually. All I can do is pass on your advice and see what happens.
Again, thankyou all so much.
X

[try to be balanced]

just to clarify ... "employment" doesn't just mean work .... it is using time productively ( full time study/ voluntary/ carer etc)

Unfortunately guidelines with alcohol and meth are fairly consistant; that will be a problem in most CDTs 
 
You sound like an angel of a parent we all would be glad to have.... keep strong, patient and consistent.

Take care

[OP8S]

Therer is a back to work project in my area available to SU's but you have to be drug free completely, my mates key sent him there they asked for a u/s , showed positive for a low dose of subs as he was reducing. They wouldn't let him in though, he could of really benefited from it if they had but as usual one hand doesn't know what the other is doing. He's off his script now with long days to fill, with either booze or gear. Square one.

[froude]

Maggie you said your daughter started her Hep C treatment ,but didnt go for the follow up ,i presume you are talking about the bloodtests you have every week ,and being weighed,ive also been through the treatment and know how many times you have to have your blood done.Those weekly visits to the hospital are a nightmare,but in the long run they are saving her life,hope the treatment worked or is working but i advise your daughter,does at least get to the hospital for a full blood count,even if it is just to see the heptology nurse ,they understand every kind of emotion your daughter is going through and as you know are trained to understand.Hope the treatment is going ok,keep well ,all the best Froude

[usandthem]

Try to be balanced: Are we going to rely on drug worker - drug user statistics here? I mean lets be honest. As a user in treatment for so many years. The main goal of many users, NOT ALL, I must add, is to throw the worker off the scent and give them the harmonious realization that all is well. Now I do not study any keyworker success and compare them to other key-work successes.

 It is true that addiction seems to want to be understood. But this is often rarely the case as it is so diverse and subject and often complex. The only treatment or most that can be treated and looked at as a success is only by sheer determination on the users part. Also little encouragement from the key-worker may impact a little. But it is not a certainty that a user who is employed is being able to do these hours without any type of medicated support or otherwise, or something to fill in the gap of addiction needs. i.e Closet users. Test dodgers.

I know this because I have lived it and have been given recovery champion status many times.  So to reduce and carry out a full time job is possible, but not always, and is often rarely attributed to a complete detox. Sometimes a family, or peer pressure, or otherwise, can impact on someone making good their steps to complete recovery. A opiate related death of a family and friend is another impact ,and also, the realization of hitting rock bottom and finding yourself fewer choices to remain in that tug of the drug circle.  

As far as I know. Substitute medication is at the heart, and is central to any recovery of opiate addiction. When stabilized, one is still addicted - but now to substitute opiates. i.e. Methadone, Subutex etc. Those that have 'come out the other side' I commend fully, as it is a long hard road, where sheer gut and determination and self prevalence is at the route of maintaining a certain pro- positive abstinent life. But lets not kid ourselves here. Pro- abstinence in recovering addicts is not always the answer, and, as we know, it also has its downsides. Abstinence works for those users that push hard for it. Training the addictive brain to become non-addictive is a slow and very difficult process. Self determination; or holding out for a better life; to co-inside with any outside pressures of wanting the user to live within the confine of 'social norms'.

 Most workers who are in treatment are able to face their daily chores of work through substitute medication, or it could be while using on the side. If we look at addiction through the eyes of 'not trying to eradicate the problem of addiction and look at addiction through the eyes of working with the problem. We may get to understand a little more of how addiction can be treated.

Oh by the way, I have heard some good stories about Subutex and how it helps those who are pro-abstinent to stay heroin free. So some good news coming out of the opiate, opioid treatment world.

I myself, advocate for maintenance and maintenance can and should be allowed to continue without pro-abstinent movements trying to scuttle its value as a successful harm reducing treatment.

John

[Jules]

Hi Maggie

First off, well done to your daughter for how far she's come but also you and your hubby for your understanding, tolerance and patience - she's a lucky girl!  I feel the same with my parents but sadly lost my Dad a few months ago.  I wanted (and still do sometimes) to just drown my sorrow but couldn't do that to my Mum as she's a good soul and the best - just like you.

I cannot stress enough the good that voluntary work can do - it's saved me every time.  It sounds trite, but helping others gives one back their self-esteem, confidence etc.  She could start off with a few hours a week (it wouldn't affect her benefit).  I've worked in an animal rescue home and a drug project.  There's a good website: www:do-it.org.uk.  It just helps to have a purpose whilst still dealing with detox, reducing etc.

I really want your efforts to be rewarded by her fulfilling her potential - rehab isn't always the best route, although I know it works for some but I would stress to her that there are other ways to get sorted.  She just has to find the right way for her.

My very best wishes
Jules

[maggiem]

Again thanks for your replies.
Through this journey I have changed my views about her treatment and yes in the begining it was first and foremost wanting her to get off the gear that was destroying her before our eyes. She went as low as she could go and only when she got to rock bottom did she take her treatment seriously. Then I wanted her to get off of methadone and get into detox but this was purely for selfish reasons and I am ashamed to admit it now. For the past 3 years she is stable and this is with the help of methadone, but the tables have turned and I think she should stay on maintainance for as long as needed and she wants to get off asap!!! Typical.
I must clarify that her decisions are hers and we only act as a back-up and support. For as long as it takes. But she is suffering with a big guilt complex about her past and wants to get back to 'normality' too quickly.  We are not saints and find her talk very frustrating because as much as we tell her she has time to sort things out she thinks her life is over as far as jobs, relationships etc etc. (28 years old).
Also she is in denial about her hep c, will not go for her follow up tests. Says its the needles but I think its the results she fears.  Obviously we would like her to to be clear of the disease.
She has asked for unsupervised and is waiting for the reply, hopefully this will be granted.  I  remember many a time driving frantically trying to get her in time to the chemist when she was working, being stuck in traffic is not good for your stress levels. Weekends and holidays were also a pain fearing the worst so if unsupervised it will be one less stress.
Sorry to go on but there really isn't anywhere that I can voice my concerns and get honest replies.  It does seem at times that her life is the only thing we talk about and it is hard to step back and forget about it!!!!  We have done all we can possibly do and we remain relatively sane.  I really cannot bare to think about others out there who have no one and struggle with addiction alone.
Believe me there have been times that I have wanted to turn my back.................but we are in a better place now.
Maggie

[froude]

Im really concerned about her Hep C treatment or should i say lack of it,id say she is pulling a fast one,the nurses that take the blood do it day in day out (ive no viens left and they still got blood out of me)and after all its only a scratch.Your daughter is young, and having treatment for the Hep will only benefit her,its better to have it now than in a few years time,being young and moderately healthy will help the treatment.At the end of the day if she is scared of the results,she has now joined me and all the others that were scared when we first went to Heptology.In the long term it can kill you and if you take the treatment you have a very good chance of getting rid of the virus,happy days all around .Maybe you could ask the Hep C nurse to ring and have a chat with your daughter.Hope she gets to the treatment and let us know how she is getting on,All the best Froude

[OP8S]

Try to be balanced: Are we going to rely on drug worker - drug user statistics here? I mean lets be honest. As a user in treatment for so many years. The main goal of many users, NOT ALL, I must add, is to throw the worker off the scent and give them the harmonious realization that all is well. Now I do not study any keyworker success and compare them to other key-work successes.

 It is true that addiction seems to want to be understood. But this is often rarely the case as it is so diverse and subject and often complex. The only treatment or most that can be treated and looked at as a success is only by sheer determination on the users part. Also little encouragement from the key-worker may impact a little. But it is not a certainty that a user who is employed is being able to do these hours without any type of medicated support or otherwise, or something to fill in the gap of addiction needs. i.e Closet users. Test dodgers.

I know this because I have lived it and have been given recovery champion status many times.  So to reduce and carry out a full time job is possible, but not always, and is often rarely attributed to a complete detox. Sometimes a family, or peer pressure, or otherwise, can impact on someone making good their steps to complete recovery. A opiate related death of a family and friend is another impact ,and also, the realization of hitting rock bottom and finding yourself fewer choices to remain in that tug of the drug circle. 

As far as I know. Substitute medication is at the heart, and is central to any recovery of opiate addiction. When stabilized, one is still addicted - but now to substitute opiates. i.e. Methadone, Subutex etc. Those that have 'come out the other side' I commend fully, as it is a long hard road, where sheer gut and determination and self prevalence is at the route of maintaining a certain pro- positive abstinent life. But lets not kid ourselves here. Pro- abstinence in recovering addicts is not always the answer, and, as we know, it also has its downsides. Abstinence works for those users that push hard for it. Training the addictive brain to become non-addictive is a slow and very difficult process. Self determination; or holding out for a better life; to co-inside with any outside pressures of wanting the user to live within the confine of 'social norms'.

 Most workers who are in treatment are able to face their daily chores of work through substitute medication, or it could be while using on the side. If we look at addiction through the eyes of 'not trying to eradicate the problem of addiction and look at addiction through the eyes of working with the problem. We may get to understand a little more of how addiction can be treated.

Oh by the way, I have heard some good stories about Subutex and how it helps those who are pro-abstinent to stay heroin free. So some good news coming out of the opiate, opioid treatment world.

I myself, advocate for maintenance and maintenance can and should be allowed to continue without pro-abstinent movements trying to scuttle its value as a successful harm reducing treatment.

John

Precisley put John.
maggiem, you're doing all you can for her by just being there & trying to support any decisions your daughter may make. I would stress the hep issue though, like Froude says she's still young & I'm sure she will cope with any side effects of the treatment because of her age. To be honest, if she's got a problem with needles she wouldn't have to go through the treatment anyway would she. If she wants to get sorted then her health takes priority, she'll have to undergo the treatment someday. Best when she's still young.