Does Methadone really help prevent relapse?

sharona97, BSN, RN · Nov 20, 2008

Just what I needed.... Enjoy

Sharona

sharona97, BSN, RN · Nov 29, 2008

Well we had the come to Jesus talk.

Had the home drug screen test in hand but didn't have to use it....

D fessed up. How could he not? Nodding his way to almost falling off the chair. Throwing up, unsteady gait..........

This morning awoke to a cigarrette burn on my 100 year old maple kitchen floor. D claims he couldn't have possibly done it.....

So the addictive thinking is almost as worse as the high...... sigh

Called him out on his source much to his surprise.

Another holiday, another set back, yet we drove home that the intervention was for his support, it was the right thing to do.

My dilemma now is do we take it further and let his social worker know? D seems to think that "they excpect this sort of thing from him"; therefore, "this reallly won't come down to my breaking the stay of committment handed to him by the judge". WRONG.

D thinks he will tell his SW on Monday.

I see the addictive thinking is going to be a great challenge for all of us.

I continually have been second guessing this situation for weeks now, don't feel quite as helpless as I did last Spring, but never the less, I still feel something that is deep and hurts.

We all suffer when the ones we love are hurting, don't we?

Sharona

jackstem · Nov 29, 2008

Yes we do, Sharona. I know how much it hurt when I found out my youngest daughter was addicted to cocaine. I had another interesting thought at the same time...I was GLAD I had gone through all of my**** because I knew what she was going through and I had the tools of my program of recovery to help her. It's also when I discovered another 12 Step program...Al Anon! Tremendously helpful in helping me detach from the anger and pain I was associating with my daughter instead of the disease.

When I find myself getting angry or upset with a sponsee who has relapsed or is in relapse mode, I change their disease from addiction to cancer. Would I be angry with someone because their cancer recurred (RELAPSED)? Of course not! So why do I get angry when the disease of addiction recurs? Because I (we) have been raised our entire lives to see addiction as a moral failing and a lack of willpower instead of as a disease that is chronic, progressive, and ultimately fatal unless intervention and treatment...APPROPRIATE treatment takes place.

It is a well accepted principle in the treatment community that it takes long term, intensive treatment in the first 90-180 days to establish a solid base for recovery. Anything less almost assures a relapse in the first 1 - 2 years! Yet the insurance companies have all essentially assured relapse by only covering 2 - 4 weeks of inpatient treatment. Outpatient treatment sounds great. But total abstinence from all mood altering substances is necessary for the brain to begin to recover from the chronic ingestion of large quantities of chemicals used to this point. If the addict uses during those critical early months of treatment, the brain doesn't recuperate and the downward spiral of the disease continues until they get arrested or die. We wouldn't accept a 2 - 4 week course of chemo for a cancer that requires 6 weeks or more! But we have no problem accepting short term inadequate treatment for this deadly disease. We wouldn't expect a diabetic to do well if they needed insulin 2 to 3 times per day if all they were prescribed was enough for once a day!

Since substance abuse isn't seen as a "real disease", it's really a lack of willpower by someone who only cares about themselves, it's easy for us to just shake our head and remark, "Well, they did this to themselves, so they deserve whatever they have coming to them." Lung cancer patients do it to themselves when they smoke cigarettes like a blast furnace! Coronary aretery disease patients do it to themselves when they don't exercise and eat a diet rich in saturated fats, sodium, etc. We don't withhold treatment from these folks because we accept their problems as real diseases!

ADDICTION IS A REAL DISEASE! The traget organ is the brain. It is altered physically and chemically leading to aberrant/abnormal behavior which is expressed by the outward signs of lying, sneaking, stealing, cheating, violent outbursts, etc. Mental health and addictive diseases aren't seen as "real" medical problems that can be successfully treated. My ex-wife and my sister are great examples. Both have chronic depression. When they take their Zoloft as prescribed they do very well. But both of them see this as some sort of weakness on their part, so they have attempted to wean themselves off the medication several times. The results were disasterous...but predictable! Their serotnin levels in their "natural state" are obiously inadequate to maintain a "normal" emotional state. The Zoloft helps regulate those levels. I cut my sister some slack on this since she's an artist. My ex-wife is an RN and not a stupid person! Yet she still sees taking Zoloft (she calls it "nutso" medicine) as some sort of weakness on her part. You can't raise your serotinin levels by shear force of will! She doesn't mind taking synthroid for the rest of her life. She doesn't mind taking Crestor for the rest of her life. But taking Zoloft? UNACCEPTABLE!

This is the thought pattern that keeps us from making significant progress in treating addiction. I just hope I live to see the day when AA and NA no longer have to exist.

Sheri, I'm sending you an email with some additional info for you and your son. I enjoyed chatting with him last night. There is hope.

Jack

sharona97, BSN, RN · Nov 29, 2008

Thanks Jackstem,

I do believe in the power of hope. Very much so. My DH and I crossed and cleared a hurdle as far as I'm concerned, last night, with the intervention.

There was no yelling. The confrontation was scary to do (with the drug screen kit inhand) but now we feel that we could easily confront again if nec.

It was very hard in some ways to really talk to him as he was blown away. But he did portray the truth at times. He got real and said I just wanted to get high.

DH and I cut him off at rationalizing and minimizing.

His house came up again, and we expressed that we feel hanging onto a house that is being foreclosed on, waiting to pack at the last minute is useless at this point. Aside from the fact that it would be so convenient for him to go there and use. We asked him to move forward. Keep himself busy, encouraged him to reach out and talk.

Thanks for doing that with the chatting last night. I suggested it and there you were. And he took the opoortunity!

I can see DH and I have come further along, as there was no real anger last night, just deep concern. We were a united front.

D. said that he knows how lucky he is to have the supportive parents he has. He agreed to sign a contract and at one time said I'll just move back to my house, but we stopped that thinking right now.

It will be a tough holiday season for sure for all of us.

Sharona

musicgirl · Nov 30, 2008

Thanks for the info.

jackstem · Nov 30, 2008

Thanks for doing that with the chatting last night. I suggested it and there you were. And he took the opoortunity!
Sharona

My pleasure! Paying it forward...that's one of the keys to maintaining recovery.

Jack :)

sharona97, BSN, RN · Dec 2, 2008

After the weekend we just went through, I'm back to my original question. Will methadone help my son from relapse?

After admitting to us on Friday night that he had relapsed (it was pretty obvious), he remained high throughout the weekend.

So Monday morning, I placed the call to his Social Worker.

She was so happy I called and had suspected for some time.

Fast forward...............

Just received a call from D. He hates me and I've crossed the line.......... so he said.

I expected this, it still hurts. There was no discussion as he hung up twice.

I believe the stay of committment is being revoked as he CHOOSE to use. I get it that it is hard. I also want desperatley to see my son alive.

So whatever it takes right?

His addiction is severe. Who's isn't right? So with methadone help him over the hump?

I have no clue what is the right choice for D. What I do know is that he needs to be in treatment, even if it means losing his job.

Sharona

jackstem · Dec 2, 2008

Sharona,

It hurts so much to watch your child turn into someone you don't know. My daughter was using cocaine and could easily have died as a result of an OD or violence (her dealer put a .45 in her face because he didn't recognize her).

Treatment for substance abuse and chemical dependence is not a one size fits all type of thing. Regardless of the reason the individual started using, the one thing that has to be addressed is the brain has been significantly altered as a result of chronic exposure to a psychoactive substance. As a result of these alterations, the addict has alterations in their psychological and emotional responses which guarantee the continued use of the mood altering substances. Withdrawal results because the body has adapted to the chronic exposure to the abused substance(s). Cravings and compulsive use of the substance(s) are the psychological results of the changes in the brain. It takes 1 - 2 years of abstinence for the brain to recuperate from the effects of the chronic exposure to the mood altering substance(s).

Since the areas of the brain affected by abuse are also involved in learning and in controlling impulsive behavior, it's difficult for the addict in early recovery to "just say no" or to comprehend and remember the information essential to maintaining sobriety. Each day without using means they are closer to the time when they CAN comprehend and retain the information and techniques necessary for long term sobriety.

Methadone is a slow onset, long acting opioid. It's used for chronic intractable pain management and to prevent withdrawal symptoms in opioid addicts. Since it has a slow onset it doesn't produce the euphoric effect seen with fast acting substances like heroin, oxycodone, hydrocodone, and fentanyl (and others). So it's not an attractive alternative for an addict pursuing a high. However, since it IS an opioid with agonist activity, it can be abused in higher doses or by IV injection to get a buzz.

Methadone is long acting because it has a high affinity for opioid receptors. This makes it a good choice for chronic pain management and decreasing physical withdrawal since dosing is every 1 - 2 days. The problem with methadone in this respect is it's variability in elimination from the body. Accidental OD occurs because high levels can be achieved even when closely monitored. Also, adding other substances such as alcohol, sleeping medications, antianxiety agents and other fast acting opioids can increase the risk of accidental OD.

Finally, replacement/maintenance therapy isn't "recovery" because it never allows the brain to "recover" from the changes associated with the disease process. If it was considered recovery, it wouldn't be called replacement or maintenance. I'm not saying it's good or bad...it just isn't recovery. You'll get lot's of other opinions on this topic. Mine is methadone can be used to keep someone from buying street drugs that may or may not be "pure". It can be used to decrease the intensity of physical withdrawal. But, unless there is an ultimate commitment to tapering the individual until they no longer take the methadone, the addiction is simply being maintained.

The problem the treatment and recovering communities have faced is inadequate insurance coverage for appropriate treatment.The most dangerous time for relapse is in the first 90 - 180 days after the individual stops taking their drug of choice. Inpatient detox and intensive therapy in those first 3 - 6 months is crucial in establishing a strong foundation for long term recovery. No one would be the least bit surprised if a person with cancer had a recurrence of their cancer after chemotherapy that lasted 2 weeks when they needed 6 - 8 weeks. It;'s only logical that an infection will recur if the person takes their antibiotics for 3 - 4 days when they need 14 or more to kill the infecting agent. Yet everyone is so surprised when an addict relapses after a week of detox and then entry in to an outpatient program. If I'm an addict and I begin to have cravings...what is there to keep me from finding my dealer? Also, studies continue to show addicts have a difficult time learning when under the influence as well as during the early stages of abstinence because of the physical changes in the brain.

If methadone is used to decrease the intensity of withdrawal, and the ultimate goal by the treatment team is to wean them from the methadone, it can be an excellent tool. But if administering methadone is the only treatment or the major form part of a treatment plan, recovery is simply being postponed.

Jack

sharona97, BSN, RN · Dec 2, 2008

I understand and agree with your theory Jackstem.

I believe that time is of the essence in an addict's recovery. I think treatment in-patient stays should be longer.

D's SS has advised that, but unless D is willing to verbally say how much he has been using the state won't pay for it. (For a longer period of time)

He is in complete denial. The argument the gov't uses is that unless he stops minimizing than the state doesn't feel he's ready to accept the reality of treatment.

I agree with that too.

It's a mad cycle of events for all.:banghead:

Sharona

nurselsteele · Dec 6, 2008

I wasn't sure where to post this question, so don't mean to step on any toes.
I have civally committed my son recently for depression, suicide attempt #2 and my new found awarness of his heavy heroin use.
I am concerned that Methadone may preempt relapse. He has chronic pain from a motorcycle accident 10 years ago. His addiction started with pain meds and then esclated to heroin.
His feedback to me is that on low doses of Methadone he can keep a quality of life that would be better for him. I don't know much about long-term use of Methadone if there is such a thing.
I'm just happy to have found him "barely" alive, and took him straight to the hospital.
Any helpful information concerning how Methadone works would be appreciated. How is a person weaned off of this?
Thanks,
Sharona:cry:

:cry: I am sorry to hear about your situation, its a sad thing when we have our children in such dier straits.

My experience only mind you; Methadone is like a crutch for some people, it helps them stand up for a time but if to much weight is put on it it will crumble. Addiction is a powerful thing, an people with "addictive" personalities tend to use methadone as a legal high.

But remember I work in a prison so i am sceptical of mostly everything!

Heroin is a very addictive drug, it can make people do things that they would have never have dreamed of on their own; without the drug.

I guess my fear with methadone is: they don't stay on 1 dose, they increaes the dose as needed to curb the cravings, of course in our prison system we do not give methadone for withdrawl of anything, the only persons that we allow to be on the methadone is our pregnant females that were on it since conception, because if we take them off the methadone the baby will die.

1st thing is to try to manage his pain; unsure of what can be given that doesnt have an addictive baseline, Tordol is one that comes to mind, when i did some time at a rehab (working as a nurse)that was the drug of choice for the addicts with chronic pain, but it doesnt work for everyone.

I feel for your struggle, i wish i had more to offer you, but my feelings on Methadone & Suboxin are very harsh because of the people that I see at the Methadone Clinic when I drive to work, I don't see most of them seeking help for their addiction , i see them seeking a free , legal high..

I have returned to read the situation from your 1st post, and the social worker is exactly right, if D isnt willing to admit that his addiction is overpowering him, than he will not benefit anything from methadone but a legal high. I have a fellow nurse who's daughter fell into heroin & had a similar situation as yours with the suicide attempts and such, she almost lost her as well, her daughter went to a rehab for 30 days approx 200 miles from home; no family is permitted to visit, no phone calls to family for the 1st 2 weeks; dedication to the addiction, and only dedication to the addiction! She is on methadone now for 2 yrs & has been clean since her admission to the rehab, she is working full time, has really come around to love life again. If someone wants it in their heart of hearts, i believe that methadone can make a difference in their lives like in my friends daughters case, but they forced her to move back home with them (she is 29 now), and they monitor her activity closely, even 2 yrs later the chance of relapse is still there, even with the methadone..

There is no easy answer for addiction, i am sorry to say!

Wish i could help.

Good Luck & I pray you find the answers to help your son.

sharona97, BSN, RN · Dec 8, 2008

Thank you Nurselsteele,

I read these supportive posts and I think about it. I see the point and I agree with the sentiments and the controversy.

But as I read on I see the story about the 29 year old daughter. D. is 29 years old. The daughter moved back home and is doing well and apparently sober. She is also on maintenace Methadone.

This is where I get so confused. We had D. move back home. 81 days of sobriety and he relapsed. I understand this better now than last Spring when we found him suicidal.

As a mother, I think maybe D. should be on methadone. He could stabilize. I honestly know now just how horrible herion addiction is. But than I think about and agree with the legal high controversy. I totally grasp that the addict's brain neds to recover without drug reinforcement to maintain "sobriety".

What if he was a crack addict? Abstinence for sure, but not maintenace medication. I also better realize the physiological ramifications that come with herion addiction. TB, elevated BP, cognitive thinking disorders, withdrawals. I read everything I can get my hands on.

And I don't get any clear answers for myself. I guess it is too subjective when it is your own child. That can be a good thing....or not.....

I haven't heard from D since I turned him in one week ago today. His last words to me were I hate your ******* guts, and you have crossed the line.

Like his SS said, he needs to be mad at you. He can't have his way anymore.

How do you deal with the BS you must hear in the jail? What keeps you strong when prisoners hammer on you or lie? Do some talk with you in a sincere way? And what do you tell them?

I really appreciate your insight. Thank you so much for your prayers and support.

I've said so many prayers. Especially with the Advent season upon us, our family was at least able to light the first candle together this year. As I lit the second candle yesterday, I was so sad. The prayers we read supported God's will for us to clean up our lives and go out and do the good work we have to offer by virtue of the gifts He has given each and every one of us.

If motherhood is a gift ( and I believe it is), I did the right thing by calling the SS worker. I was determined not to have another holiday at the ER or receive a call from D all messed up. I wanted to nip it in the bud. He did spend Thanksgiving with us, it was when he left with his wife that he relapsed that night.

Again it is maintaining sobriety that I am focused on. Healing for D and our family. I am just very confused about the methadone alternative.

Thank you again, feel freee to pm me.

Sharona

sharona97, BSN, RN · Dec 8, 2008

As far as doing things "they" would never do without the drug hits home. I am detached form the hurtful words and the disapperaing act he's used over the last 3 years. Yeah it hurts but I am not fooled.

I told the SS worker that my dh and I would like to attend the family meetings, but we will wait until we get a call from D. If he calls.

I've always believed in my heart that D will always call. And through out his life in other circumstances he has called. And we have always been there.

D is so totally elusive when I see him high. He doesn't think his outward appearance "shows" that he is high. He wobbles around and looks me in the eye and says " no Mom, why would I get high". I simply walk away.

The Sunday eve before I called the SS worker I knew I was going to make the call. I was not torn about doing this. I wanted my kid to live.

Now he needs to focus on the healing. I get it. I wish I had the answer as to how that will happen and keep him sober. :banghead:

Maybe it's the old adage, time is of the essence.

Sharona