My son is 21. I found him near death - heroin overdose - in February. Five days in intensive care, 30 days in rehab. went back to college and it all started again. Only worse. He was just snorting crushed pills. I recently found needles in his room. I just put him on suboxine. How do I tell what is suboxine and what is using? Should his eyes still be dialated? Should he have slurred speech sometimes? How long until we begin to ween him off.
Honestly, I'm not sure he wants to stop. It's so hard to tell. He is a very good liar - has an excuse for everything!!! I go from being scared to death to so angry to just wanting to throw him out - all in one day!! How do I do this?
Thanks you!!
Addiction is hard to understand. I don't really understand it myself and I've been an addict for over 15 years (clean for 7). It really goes against human nature and our survival instinct. Not even the scientists know what causes addiction and exactly what it is but they do know one thing that is very important for anyone dealing with addiction to understand and that is that it's a brain disorder. Something is wrong in the brain of an addict that causes all these irrational actions and behavior. For someone who has a true addiction it is not a willful behavior any more than a person with bi-polar disorder chooses to go on excessive shopping sprees or paint the kitchen at 3 in the morning.
Suboxone is a great treatment for opiate addiction but like with any treatment for addiction it won't work if the person don't want it to. That is probably the biggest problem with addiction - getting the addict to want to stop. When an addict first uses their drug of choice it's like falling in love and quitting is like breaking off a relationship with someone you are up over your head in love with. It's not too hard to understand that someone wouldn't want to break off that relationship. Most are ambivalent. They know, intellectually, what continuing to use can do but they are so in love that their thinking is clouded and something stronger takes over. Unfortunately it often has to get really bad before an addict can imagine breaking the bond with the drug. I know it's hard to understand but we are not dealing with sound, reasonable minds. You have to remember that you are dealing with someone who is sick. Not someone who is just bad.
There is a common misconception when it comes to opiate addiction (heroin, oxycontin, etc.) and that is that the addict can't stop because they get sick if they don't get the drug. That's not true though. It;s only a small part of the problem. It's not that hard to quit using drugs. What's hard is not to start again. The physical part is not the addiction as some think. The physical need for the drug is called dependence and has nothing to do with the addiction. It just complicates things. Many people, like people who are treated with methadone or suboxone or those who are treated with opiates for pain, are dependent without being addicted. And many people are addicted without being dependent.
Opiates, which Suboxone is a synthetic version of, does not make someone's eyes dilated. Opiates causes the pupils to get small, sometimes pinpoint. Upper drugs, like methamphetamine and cocaine, will make the pupils dilated. An opiate addict who is in withdrawal can also have dilated pupils. It's possible that your son is not getting a high enough dose of Suboxone causing him to be in a constant stage of mild withdrawal which would cause his pupils to be bigger. His pupils should be smaller than normal or normal. The pupils should be the smallest an hour or so after he takes his dose and may get closer to normal as the day goes on and the levels of the drug drops in his system. It is of course possible that he's also using other drugs. To find out for sure you can buy an at home drug test and make him take it with no forewarning.
His speech should not be slurred from taking Suboxone. At least I have never heard of it. I can't imagine why it would cause the effect. Many opiate addicts like to take benzodiazepines, like Valium or Xanax, and that can cause slurred speech. If you drug test him make sure it tests for benzos.
Are you sure he's taking the Suboxone every day? People who are not really wanting to get clean may skip days so that they can get high on those days. Suboxone blocks the effects of other opiates so he can't get high if he would try to use heroin but if he skips the Suboxone for a day or two the blocking effect would go away. He could still get high from other drugs. You may want to watch him take his dose every day.
If your son's pupils are looking dilated and you suspect that he's used an upper drug you can see how his pupils react to light to try to determine if he's used or if he may be in mild withdrawal. If you shine a flashlight right into his eyes the pupils will constrict right away and when you remove the light the pupils will dilate. But when someone has used drugs the pupils will not react to light. The Suboxone will of course also have this effect to an extent but the pupils should not be big due to the Suboxone. The light test not 100% foolproof but it's usually pretty accurate.
As you said, your son lies a lot and that's pretty standard for addicts. Addicts want to protect their relationship with the drug and will do almost anything to make sure that nothing will come between him and his best bud. Since you are trying to break off this relationship he will lie to prevent that from happening. If saying that he wants to quit will get you off his back then he will say that. The best way to keep you off his back is to pretend to be drug free so he will go to great lengths to make it look that way. All an active addict wants is to be left alone with his beloved drug. When I was in active addiction I was extremely manipulative. I would go through a whole rehab and do everything that was expected of me just so that I could get out quicker so that I could go back to my relationship with heroin. Gaining people's trust would give me more freedom to use so I did that. It's a very sick way of thinking and acting. It wasn't always conscious either. I could lie to myself and believe it. I don't know how many times I convinced myself that I could use just one more time or just use on weekends. After having failed the exact same thing several times I still managed to convince myself that i could do it. If only I could do A, B and C it would work. Of course it never did.
I'm not saying that you should never trust what your son says but take it with a grain of salt. If nothing else than to protect yourself from the hurt of being let down when your son doesn't live up to his promises. When dealing with an addict it's very important to look out for yourself too. You going down into despair with the addict is not going to help either of you.
Unfortunately, in my experience, it is harder to get younger people to quit using because they are so new in their addictions that it hasn't gotten bad enough yet. An addict has to reach a point where he's willing to take the steps to get better. That doesn't mean that you shouldn't keep trying but I think it's important to have realistic expectations. It's not like on TV where someone goes to rehab and lives happily ever after.
I think you did the right thing by putting him on Suboxone. For opiate addicts the success rates for treatments that don't use medication are very low, less than 5% on average. The rates for Suboxone or methadone treatment are significantly better, although nowhere near 100%. It's not uncommon that people have to try it a couple of times before they finally get in and stick with it. Methadone and Suboxone works very well if done correctly. One thing that is very important is the dose. It has to be sufficient or it won't work and what is sufficient is different for each person. What's your son's dose? If it's too low chances are that increasing it and making sure that he takes it every day at the same time that it will work. Suboxone and methadone both helps the areas in the brain that causes the sick thinking and cravings that causes the addict to keep using.
Another thing that is important for success is time. He should be on medication for at least 2 years before he starts tapering. Take him off any sooner and it's almost a guaranteed failure. Some people have brains that are so messed up that they will need medication for a very long time or for life. I have been on medication for 7 years and I know that if I stopped taking it my sick thinking would come back and I would relapse. I'm not willing to take that risk. The longer in treatment the better regardless of what treatment it is. Even if he keeps using here and there don't take him off the Suboxone. It's not uncommon that people will use some for the first few months of medication-treatment but will eventually get better.
If the Suboxone, when taken daily at the correct dose, does not work after a while and your son still experience cravings and thoughts of using I would recommend trying methadone. Some people have better success with methadone. The two medications work very similarly but there are some differences. Another benefit with methadone maintenance is that in the beginning he would have to go to the clinic every day to take his medication there which is very helpful if he has compliance issues. He would only get doses to take home once he's earned it by staying clean and doing well in general. The clinics offer a bit more rigorous treatment than most Suboxone doctors do. There are a lot of stigma and misconceptions surrounding methadone that causes people to think it's something bad. Something they surely wouldn't want their kids on. But few of the things you've heard about methadone are likely true. It doesn't make you high. It's not switching one addiction for another. It's not "liquid handcuffs". It's not impossible to get off, etc. It's a legitimate treatment that works for a lot of people.
I didn't mean to write you a book here but clearly I did. I hope you made it through the whole post without falling asleep. There is just so much to explain regarding addiction. It's not a simple issue. If you have any questions please feel free to ask.
Good luck!
I so appreciate your responding.... I made one mistake - his eyes are not dialiate his pupils are very small - sometimes pin-like.
Please share your thoughts on AA. I had him attend an IOP after rehab. It did not go well. He is a pretty private person normally so to put him in a circle setting to share his deepest darkest secrets did not work He was very aggitated with the counselors. Now he is in one-on-one sessions with a psychologist. I am hoping to sit in on part of his session - I would like to have the counselor know my perspective of what has and is transpiring.
Thank you!!!