Harm Reduction Model: Thoughts?
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Join Date: Mar 2013
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Harm Reduction Model: Thoughts?
I posted for the first time a couple of weeks ago, struggling with detachment as a parent. My 25-year-old daughter returned home 3 months ago from intensive wilderness and and residential care.
Her underlying problem is depression and her DOC is ketamine and DXM, and she uses weekly (rather than daily) while going to school and is currently in therapy once a week. Her therapist seems to operate from a harm reduction rather than abstinence model.
Her father and I are currently paying for her therapy, less a $20 contribution she makes. It's the only support I am giving her at this point, and I have put some hard boundaries around our contact.
But here's my question: she certainly doesn't appear ready yet to do the real work she needs to do, but is it better to maintain this therapeutic relationship with someone she appears to trust, while still using, in the hope she'll get to a point of real commitment to change?
Or is it maintaining an illusion of her doing the work? And will she get to that place of commitment to change faster if left on her own, to experience the full consequences of her choices?
Thanks for any insights,
FL
Her underlying problem is depression and her DOC is ketamine and DXM, and she uses weekly (rather than daily) while going to school and is currently in therapy once a week. Her therapist seems to operate from a harm reduction rather than abstinence model.
Her father and I are currently paying for her therapy, less a $20 contribution she makes. It's the only support I am giving her at this point, and I have put some hard boundaries around our contact.
But here's my question: she certainly doesn't appear ready yet to do the real work she needs to do, but is it better to maintain this therapeutic relationship with someone she appears to trust, while still using, in the hope she'll get to a point of real commitment to change?
Or is it maintaining an illusion of her doing the work? And will she get to that place of commitment to change faster if left on her own, to experience the full consequences of her choices?
Thanks for any insights,
FL
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Join Date: Jul 2012
Posts: 793
I would have trouble paying for it knowing she is still using, especially if I had paid lots of money for wilderness therapy & inpatient rehab. But if you are not burdened by it financially, I guess knowing that she may find support she needs with her therapist would be a comfort. It all boils down to what YOU are comfortable with, what you are willing to do for her that does not hinder your own recovery.
My other question is, how do you know she is only using weekly? Or is that what she has told you? My RAD overdosed on heroin, woke up in the ICU ten days later only to tell everyone she'd only used twice...that was a big lie we believed and only discovered many months later when she relapsed. My point is, how much she is using can't be part of your decision. It doesn't matter. She's using after being treated. How does that make YOU feel? I have been in your shoes, I am in them now, too, actually, walking alongside you. I hope you get some peace and quiet and a deserved break. Things I wish for myself.
My other question is, how do you know she is only using weekly? Or is that what she has told you? My RAD overdosed on heroin, woke up in the ICU ten days later only to tell everyone she'd only used twice...that was a big lie we believed and only discovered many months later when she relapsed. My point is, how much she is using can't be part of your decision. It doesn't matter. She's using after being treated. How does that make YOU feel? I have been in your shoes, I am in them now, too, actually, walking alongside you. I hope you get some peace and quiet and a deserved break. Things I wish for myself.
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Join Date: May 2012
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My personal belief is that efforts to support a person’s recovery and maintain relationships are valuable even if they are currently centered on harm reduction. (My preference would always be abstinence, but its hard to say what the ultimate goal of the therapist is from my vantage point.) But, I think if your daughter is willing, as is attending therapy sessions then she is being provided with an open link to learning about her addiction, understanding how to control it, and there is opportunity for the therapist to advance this view into an agreement of abstinence.
My husband did his recovery based on private therapy, so most of my beliefs come from his doctors. Their beliefs are based in science, and are supported by organizations like the National Institute of Drug Abuse, and the Substance Abuse and Mental Health Services Administration.
Based on these sources, I wanted to share some of NIDA thoughts on the importance of continued treatment, and the role they suggest family plays in encouraging this:
HBO Addiction Project - Frequently Asked Questions | National Institute on Drug Abuse
NIDA is involved with a project airing on HBO called Addiction:
HBO Addiction Project - Frequently Asked Questions | National Institute on Drug Abuse
These are some articles shared from HBO Addiction:
HBO: Addiction: Aftercare: What Helps People Stay in Treatment?
HBO: Addiction: Treatment: Getting Someone into Treatment: CRAFT: An Alternative to Intervention
The book mentioned in this link of CRAFT method, I have read. Its also supported by Family Members who use Smart Recovery: Self Help Substance Abuse & Addiction Recovery | SMART Recovery®
The key to family support as I have learned is for each of us to make proper boundaries, and make sure we take care of our needs first.
My husband did his recovery based on private therapy, so most of my beliefs come from his doctors. Their beliefs are based in science, and are supported by organizations like the National Institute of Drug Abuse, and the Substance Abuse and Mental Health Services Administration.
Based on these sources, I wanted to share some of NIDA thoughts on the importance of continued treatment, and the role they suggest family plays in encouraging this:
HBO Addiction Project - Frequently Asked Questions | National Institute on Drug Abuse
NIDA is involved with a project airing on HBO called Addiction:
HBO Addiction Project - Frequently Asked Questions | National Institute on Drug Abuse
These are some articles shared from HBO Addiction:
HBO: Addiction: Aftercare: What Helps People Stay in Treatment?
HBO: Addiction: Treatment: Getting Someone into Treatment: CRAFT: An Alternative to Intervention
The book mentioned in this link of CRAFT method, I have read. Its also supported by Family Members who use Smart Recovery: Self Help Substance Abuse & Addiction Recovery | SMART Recovery®
The key to family support as I have learned is for each of us to make proper boundaries, and make sure we take care of our needs first.
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Join Date: Mar 2013
Posts: 10
GardenMama - good question about how it makes me feel. I feel a lot of conflict and discomfort.
I know she can't really commit to doing the work until she makes a commitment to give up the drugs, and I hate supporting anything that supports her drug use - but then I think, she is showing up for her therapy appointments every week, so maybe this is the one thing that will lead her to stop? It's like going straight to do the work; or doing the work (in this case committing to her therapy) to go straight, and then do the rest of the work?
You're right about what she says versus reality. I don't know what reality is. I can only look at outcomes. She's finishing her semester at school in the next week; when I see grades, I'll be able to tell if she put the time and effort in.
I'm not wealthy -- I have a middle-class income, the kind that let me borrow enough on a line-of-credit to pay for her long-term treatment; so I'm paying that off every month now. I split her treatment with her father (we've been divorced since she was 9), as I do her current therapy sessions.
I'm at an age where I should be saving more for my own eventual retirement (no pension), so I'd be better personally diverting those funds elsewhere....but she's my daughter. And if this is the chance for her to become well....
Did I say I was conflicted?????
I know she can't really commit to doing the work until she makes a commitment to give up the drugs, and I hate supporting anything that supports her drug use - but then I think, she is showing up for her therapy appointments every week, so maybe this is the one thing that will lead her to stop? It's like going straight to do the work; or doing the work (in this case committing to her therapy) to go straight, and then do the rest of the work?
You're right about what she says versus reality. I don't know what reality is. I can only look at outcomes. She's finishing her semester at school in the next week; when I see grades, I'll be able to tell if she put the time and effort in.
I'm not wealthy -- I have a middle-class income, the kind that let me borrow enough on a line-of-credit to pay for her long-term treatment; so I'm paying that off every month now. I split her treatment with her father (we've been divorced since she was 9), as I do her current therapy sessions.
I'm at an age where I should be saving more for my own eventual retirement (no pension), so I'd be better personally diverting those funds elsewhere....but she's my daughter. And if this is the chance for her to become well....
Did I say I was conflicted?????
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Join Date: Mar 2013
Posts: 10
allforcnm -
What you say makes sense. What gives me any hope is that my daughter has committed to the therapy sessions. She appears to have established a trusting relationship, and even though it seems the therapist may not be 'therapeutically challenging' her as much as I might like yet, it is her journey, it is her therapy. It's not mine.
FL
What you say makes sense. What gives me any hope is that my daughter has committed to the therapy sessions. She appears to have established a trusting relationship, and even though it seems the therapist may not be 'therapeutically challenging' her as much as I might like yet, it is her journey, it is her therapy. It's not mine.
FL
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Join Date: Mar 2002
Location: By The Lake
Posts: 60,328
This is from one of the links allforcnm posted here...
A agree with most of what it says, particularly the part about finding support at Al-anon...that fellowship has helped so many here.
The only part that makes me squirm is #4. I don't believe we should do for them what they can and should do for themselves. And where it says "support", I agree with cheering them on, but not throwing money at it. The Salvation Army has a wonderful rehab program and it is free. We cannot buy their recovery.
Harm reduction programs, I believe, help keep active addicts safer...through controlled dosages, free clean needles and safe injection sites, as examples, but I don't have a lot of faith in them helping an active addict find complete sobriety, and for most, that's the only way they beat addiction is to put down the drug..period.
My prayers go out for your daughter. As a mama of an addict I know your pain.
FIVE THINGS FAMILIES CAN DO TO SUPPORT RECOVERY OF A FAMILY MEMBER
Experts have long known that addiction can negatively affect all family members and disrupt family relationships. But recent studies have also shown that recovery from addiction can also exert great strain on family members and family relationships at the very time family relationships have to be readjusted to meet the realities and demands of recovery. Here are several things family members can do to help speed these adjustments:
1. Educate yourself on the recovery process for individuals and families.
2. If your recovering family member is living with you, provide a sober environment to support that recovery.
3. Seek professional and peer support (from a group like Al-Anon) for your own physical and emotional health. Support your family member's involvement in treatment aftercare meetings and recovery support groups.
4. Assist the recovering family member with assistance in locating sober housing, employment, child care, transportation or other recovery support needs.
5. Assertively re-intervene in the face of any relapse episode.
Experts have long known that addiction can negatively affect all family members and disrupt family relationships. But recent studies have also shown that recovery from addiction can also exert great strain on family members and family relationships at the very time family relationships have to be readjusted to meet the realities and demands of recovery. Here are several things family members can do to help speed these adjustments:
1. Educate yourself on the recovery process for individuals and families.
2. If your recovering family member is living with you, provide a sober environment to support that recovery.
3. Seek professional and peer support (from a group like Al-Anon) for your own physical and emotional health. Support your family member's involvement in treatment aftercare meetings and recovery support groups.
4. Assist the recovering family member with assistance in locating sober housing, employment, child care, transportation or other recovery support needs.
5. Assertively re-intervene in the face of any relapse episode.
The only part that makes me squirm is #4. I don't believe we should do for them what they can and should do for themselves. And where it says "support", I agree with cheering them on, but not throwing money at it. The Salvation Army has a wonderful rehab program and it is free. We cannot buy their recovery.
Harm reduction programs, I believe, help keep active addicts safer...through controlled dosages, free clean needles and safe injection sites, as examples, but I don't have a lot of faith in them helping an active addict find complete sobriety, and for most, that's the only way they beat addiction is to put down the drug..period.
My prayers go out for your daughter. As a mama of an addict I know your pain.
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Join Date: May 2012
Posts: 1,927
Originally Posted by Ann 
This is from one of the links allforcnm posted here...
A agree with most of what it says, particularly the part about finding support at Al-anon...that fellowship has helped so many here.
The only part that makes me squirm is #4. I don't believe we should do for them what they can and should do for themselves. And where it says "support", I agree with cheering them on, but not throwing money at it. The Salvation Army has a wonderful rehab program and it is free. We cannot buy their recovery.
Harm reduction programs, I believe, help keep active addicts safer...through controlled dosages, free clean needles and safe injection sites, as examples, but I don't have a lot of faith in them helping an active addict find complete sobriety, and for most, that's the only way they beat addiction is to put down the drug..period.
My prayers go out for your daughter. As a mama of an addict I know your pain.
A agree with most of what it says, particularly the part about finding support at Al-anon...that fellowship has helped so many here.
The only part that makes me squirm is #4. I don't believe we should do for them what they can and should do for themselves. And where it says "support", I agree with cheering them on, but not throwing money at it. The Salvation Army has a wonderful rehab program and it is free. We cannot buy their recovery.
Harm reduction programs, I believe, help keep active addicts safer...through controlled dosages, free clean needles and safe injection sites, as examples, but I don't have a lot of faith in them helping an active addict find complete sobriety, and for most, that's the only way they beat addiction is to put down the drug..period.
My prayers go out for your daughter. As a mama of an addict I know your pain.
Nature Girl
Join Date: Mar 2002
Location: By The Lake
Posts: 60,328
Originally Posted by allforcnm
I would love a link to that Ann.
HBO: Addiction: Aftercare: What Helps People Stay in Treatment?
Getting there!!
Join Date: Mar 2012
Posts: 5,750
This just my experience.
When I was teen, my parents divorced. I was angry and confused and started experimenting with drugs. My mother jumped on it and found a therapist who came to my house. Now, I was really rebelling, refused to meet with her, showed up high, refused to let her in, had my friends over, etc, etc. A real pain in the butt.
She didn't give up on me, no matter how hard I tried to run her off. Eventually, I started to talk to her a little, then a little more and more. I started to look forward to seeing her, so did my friends. Long story short, after a while, I stopped all drug use, with the exception of alcohol. By the grace of God, I never became addicted to any drugs.
This same therapist helped me make some long term goals and apply to colleges. When I graduated high school and college, she was standing next to my mother with a smile just as bright. I love her dearly and we have stayed in touch over the years. She will always be in my heart.
In fact, I think I will give a call tomorrow!
When I was teen, my parents divorced. I was angry and confused and started experimenting with drugs. My mother jumped on it and found a therapist who came to my house. Now, I was really rebelling, refused to meet with her, showed up high, refused to let her in, had my friends over, etc, etc. A real pain in the butt.
She didn't give up on me, no matter how hard I tried to run her off. Eventually, I started to talk to her a little, then a little more and more. I started to look forward to seeing her, so did my friends. Long story short, after a while, I stopped all drug use, with the exception of alcohol. By the grace of God, I never became addicted to any drugs.
This same therapist helped me make some long term goals and apply to colleges. When I graduated high school and college, she was standing next to my mother with a smile just as bright. I love her dearly and we have stayed in touch over the years. She will always be in my heart.
In fact, I think I will give a call tomorrow!
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Join Date: Mar 2013
Posts: 10
Hi Ann - thanks for the link. This stood out for me in the article:
Another vital element of continued treatment: dedicated work by family members and friends to support the person in treatment. This is never easy.
"It takes almost a saint in a way to sort of maintain a loving supportive engagement with somebody who may be doing things that really hurt you," acknowledges Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism. "I mean, they may be spending a lot of money. They may be acting irresponsibly. They may be saying hurtful things."
Nonetheless, emotional support - not only from family members and friends, but also from counselors, physicians and other healthcare practitioners - is essential for an addicted person.
For me now the real struggle is finding that balance between emotional support and detachment that feels so very confusing.
Another vital element of continued treatment: dedicated work by family members and friends to support the person in treatment. This is never easy.
"It takes almost a saint in a way to sort of maintain a loving supportive engagement with somebody who may be doing things that really hurt you," acknowledges Dr. Mark Willenbring of the National Institute on Alcohol Abuse and Alcoholism. "I mean, they may be spending a lot of money. They may be acting irresponsibly. They may be saying hurtful things."
Nonetheless, emotional support - not only from family members and friends, but also from counselors, physicians and other healthcare practitioners - is essential for an addicted person.
For me now the real struggle is finding that balance between emotional support and detachment that feels so very confusing.
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I can only speak for me, but I never really got the chance to emotionally support my son in "recovery"
I have come to need detachment in order to protect myself, and in the hope that it may not be as easy for him to remain as he is.
When the addict is spending my money, speaking and acting hurtful and irresponsible in my home, it's up to me to remove myself from the situation ( i.e. remove him).
It may sound selfish, but my life ( and my relationship with others in the family ) are just as important as my relationship with my son.
I held onto what was more healthy for all.
I have come to need detachment in order to protect myself, and in the hope that it may not be as easy for him to remain as he is.
When the addict is spending my money, speaking and acting hurtful and irresponsible in my home, it's up to me to remove myself from the situation ( i.e. remove him).
It may sound selfish, but my life ( and my relationship with others in the family ) are just as important as my relationship with my son.
I held onto what was more healthy for all.
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